Tuesday, November 20, 2007

The Groening of Weight Loss Surgery



The parents of Matt Groening, creator of the Simpsons, were friends of my parents. It might interest his fans to know, if they don't already, that his parents' names are Homer and Marge. Several years ago, my mom got Marge Groening to finagle a favor from Matt: he sent our son, on his birthday, several items of wittily signed simpsonalia, along with a couple of original drawings of Bart offering greetings, relating, as I recall, to a cow. This does not keep me from criticizing Mr. Groening on surgical matters.

On the most recent Simpsons episode, which I watched with my usual devotion, Homer underwent weight-loss surgery. During the pre-operative meeting with the surgeon he was told about "gastric bypass surgery," but the explanation, complete with diagram, was of placing a band around the stomach. There's a lot of misunderstanding out there.

Before I became a blogger, I spent some time voluntarily answering medical questions on a couple of online medical fora. Weight loss surgery, I discovered, is a little like religion. Criticize gastric bypass in favor of lap-band, and expect serious flaming. When I predicted that, as the word got out, lap-band would replace gastric bypass as the procedure of choice, personal epithets were flung far, fast, and furious, as if I'd said Osama bin Laden ought to be president. The fact is that when most people think of bariatric surgery, gastric bypass is what comes to mind; and to date, it's what most have had (although the teeter is tottering). Good branding. Like MP3 player = iPod. But iPods don't kill 1.5% - 3% of their owners within days of purchase.

Disclosure: to the extent that I'm still a surgeon, it's only as a participant in the laparoscopic placement of lap-bands. Further disclosure: they pay me by the hour. Got no dog in the fight. Statement: if I were going to have a weight loss operation (and, depending on where I am on the sine-wave of my devotion to cycling and other factors, it's not inconceivable) there's no doubt I'd have the lap band. Why? Cheaper, safer, faster, doable as an outpatient procedure, quicker recovery, equal weight loss in the long run. More disclosure: not even all bariatric surgeons would agree with what I just said -- mainly the last phrase.

It's a strange world. Until pretty recently, those insurers who covered bariatric surgery (not many, for a long time) only paid for bypass, despite significantly higher initial cost and much more frequent (and very dangerous -- not to mention expensive) complications. In part, they claimed it was because (despite much world-wide experience with tens of thousands of patients) they considered the band "experimental." Cynical me: I think it's really because they figured that in covering only the more expensive and more dangerous operation, fewer people would choose to have it. Short sighted? Surprised?

Ain't no free (small) lunch. The main downside of lap band, as I see it, is that it affords less of having and eating your cake. Bypass works in significant measure by causing malabsorption of food. Stuff passes through. Although that often leads to diarrhea and nutritional problems for which the typical patient must take lots of supplements (as opposed to the typical band patient who needs none), some people are attracted to it because they may not be as restricted on intake. With a band, you can't eat as much, and you may need to give up certain things, like bread. On the other hand, a high percentage of people with a band in place find their appetite is wiped away like spilled crumbs in a white tablecloth restaurant. And there's this: the best results are with programs that are comprehensive and provide ongoing support. Some surgeons, of course, don't like that; which, I think, accounts for the disagreement amongst them. Cut and run, is what they prefer, and that's what they can more easily do with bypass patients. The people with whom I work set a very high standard of continuous followup.

Adjustability is another attraction of the band. There's a small "port" placed under the skin into which fluid can be injected, which fills a balloon on the inside of the ring. You can make it tighter or looser, depending on a patient's needs. Women who'd had trouble conceiving a baby while fat may get pregnant when thin, and need a little more room to eat for two. No problem.

Since there's none of the cutting of bowel and stomach that happens with bypass, there's practically no incidence of leakage or serious immediate surgical problems. Mortality rate is much lower (for the group with which I work, it's one (last I heard) in about three thousand.) The most irksome problem with the band is an incidence of "slip," wherein too much stomach ends up above the band, often requiring re√∂peration to reposition it. I think it's generally a misnomer, because in most cases it's not that the band has slipped, but that the originally small portion of stomach above the band has become stretched and dilated; which nearly always happens in people who go off the reservation, meaning people who force in too much food and end up vomiting a lot. Technical issues that might also be a factor are slowly being investigated and placement techniques have changed, which has lowered the incidence. That, of course, says that not all the problems are related to patient co√∂peration. (Love that ¨ thing, since I discovered how to do it recently.)

So. If you're like me and you get most of what you know about the world from watching the Simpsons, be of good cheer. As long as there are people around to correct the (very rare) occasional divergence from reality, you can keep watching with confidence. The internet is a wonderful thing.


52 comments:

rlbates said...

I like this post, Dr Sid. I also want to direct anyone interested to Chris Oliver Blogspot: Laparoscopic Adjustable Gastric Band Story - Surgery February 2007

He is an orthopedic surgeon who is blogging about his weight loss surgery/story.

http://christopheroliver.blogspot.com/

Sid Schwab said...

Thanks, Ramona. I went over there and checked it out. Coincidentally, in one of his posts he mentioned a book, sort of the bible for lap band patients, which was written by a woman with whom I now work.

Eric, AKA The Pragmatic Caregiver said...

Funny, as I watched this episode, I thought of you; the disconnect between the words and pictures was . . . jarring.

I did, however, enjoy the speed of the results and the ease with which Homer moved the excess skinrolls around to suit.

Eric, Just Folding Up A Sweaty Old Blanket

Lynn Price said...

I always wondered why I never heard anything about the lap band anymore. Seemed like it was a smarter way to go - less invasive, cheaper, offered fewer side effects, and yielded the same results. Thanks for this post, Sid. Now pass the candy.

Bongi said...

love the simpsons.

i sincerely hope you are not going to stop blogging???

make mine trauma said...

..his parents' names are Homer and Marge.
GET OUT!

Also loved the way Homer handled the loose skin.

Seems the bariatric group in my area have pretty much converted to all lap bandings. Occasionally a patient will still insist on the gastric bypass.
Lap band procedure also seems to take about 1/2 the time it takes to do a bypass.

Sid Schwab said...

MMT: get out? check it out. (also note the names of his sisters; and his sons.)

He was born in Portland, as was I. His mom and mine were in the same book group. Actually still are, although mine doesn't get there much any more.

SeaSpray said...

Good post! I know quite a few people that had the Bi-pass surgery and all are glad they had it. One had months of trouble. And she recently had to do something again because she has started to gain but I don't know the details. Diabetes, htn and aching joints reversed or greatly improved. One man in his 40s died s/p that surgery because of a wound infection that didn't clear up. Again don't know details.

Here's the thing and this is just my opinion and I would NEVER say it to anyone nor indicate it. I am very positive around them and applaud their successes. BUT...I think they age and look haggard. I think it must be because the weight comes off so fast. That being said morbid obesity with co-morbidities can kill you and sets up for a potentially dismal future. There's probably exceptions but it's inviting poor health.

Most recently, someone from church had it done in May. She had been opposed to it a couple of years ago. Her sister was one of the first ones to have it done back in the 70's and she had to travel out of state to get it done. She had a miserable time of it and they didn't have the support systems/follow-up they have in place now. She is happy and supportive of her sister but would never do it again. She did regain the weight. The woman I know lost 80lbs between May and October and is very happy about it and said she would do it again. I only know of one woman personally who got the rubber band procedure but I don't know the outcome because I had stopped working at the hospital in which she worked as a nurse.

Why don't more people opt for the rubber band procedure? or is that what you are saying that it may not be covered by insurance? It's amazing what surgeons can do today.

Happy Thanksgiving to you and your family Sid. :)

Sid Schwab said...

seaspray: your observation is correct, and it's an aspect of the malabsorption that results from bypass, as opposed to lap-band: they can develop forms of malnutrition that leads to protein-wasting, etc. Others have noticed as well that people who've lost lots of weight look "worse" after bypass than after band.

SeaSpray said...

Right there-that's it Sid! Some people don't pay attention to the health consequences but if the message got out about their post-op appearance re- bypass vs bands...I really think it would be the draw.

Buckeye Surgeon said...

The problem with the lap band is the follow up. The gastric pouch will dilate over time, requiring repeated adjustments of the band. You have to follow these people for a lifetime. And not to be crude but Ive found that bariatric patients can be a little "difficult" to say the least. So it requires many years of patience from the surgeon. A patient with a roux-en-Y can disappear from your office forever and still continue to lose weight over their lifetime. Of course, there's that little problem of the risk of anastomotic leak and horrible death that you have to deal with.

My favorite Simpsons: When Homer became the Springfield Beer Baron. "Alcohol; the cause and solution to all of life's problems..."

Sid Schwab said...

I'd change the word "will" to "might." I know many "bandees" who've had them for many many years with zero problems. I agree about the followup, which is in my post. I've also been involved in "band over bypass" patients, ie ones we banded after their bypass operation failed. None of the options is perfect, and ought to be a last resort for those in whom all other serious attempts haven't succeeded.

Bongi said...

nothing to do with the whole argument (but i sway slightly in the gastric bypass direction myself) but buckeye's quote of homer made me think of another quote.

beer is not the answer. it is the question. the answer is yes.

Dr. Rob Oliver said...

Bands clearly do not have the track record of GBP with predictable and long-term results. I think they're great, but they're really better suited to subsets of patients who're needing 60-80 lb weight loss. Patients requiring 125-200 lbs really need the more dramatic surgery (GBP) to realize sustained benefits, and I believe that experience is pretty consistant in the literature.

Also agree with buckeye surgeon, many surgical weight loss patients do not have the compliance neccessary to do as well with bands nor do most surgeons have the infrastructure to follow these people out 15-20 years.

I'm still kind of waiting for the other shoe to drop with the lap-band. Surigcal history of such "choker collar" devices around the stomach was kind of ugly. Are we going to see a wave of pressure ulcers of the stomach from these at 15-20 years out?

Sid Schwab said...

Rob: the group I work with takes on all comers and has many with weightloss of 150 pounds and more. The band has been around long enough, and modified along with implantation techniques that I think erosion has been well addressed. And in those rare cases in which it happens, the result is simply that weight gain occurs, as opposed to septic complications. Then the band gets removed. I absolutely agree about followup, which I mentioned. I still think, comparing the short term death and complications of bypass and the long term issues with band, when followed properly, the data come down on the side of band. But, as I said, I have no dog in the fight...

Anonymous said...

Sid,

I'd be mildly interested to know what group you've worked with, as I'm only familiar with people on the east coast.

I know some well-known surgeons who have been successful with the band. I also know a vast majority of patients who use it as an excuse to simply eat badly in small portions, maintain their 6L of Pepsi a day and then act surprised when the weight doesn't come off. I'm also fairly disturbed by how many reputable surgeons use the vomit-point as their cutoff for successful band adjustment (incidentally, do your people do adjustments in office or in the radiology suite?). I've thus noticed an increasing number of people who have esophagi that would horrify you in their diameter in barium swallow. Finally, none of them seem to understand that when the band comes off, the weight will come back if they return to their old eating habits.

I do think that the fewer complications (nutritional and surgical), ease of placement, and suitability for BMI 35-40, adolescents and high-risk cases is good, but I'd like to second Buckeye on the long-term data. The Italian and other European data works with a different population in terms of eating and exercise and I'd love to see US follow-up data in about ten years, now that we've mostly formalized technique, to see if it really was generalizable.

I think we'd all agree that many weight loss patients are don't understand the long-term ramifications of a major surgery, especially one like RNYGB that depends on malnutrition to cause an effect. My personal opinion is that we ought to make stringent psych evaluations (administered by an evaluator unfamiliar with both the surgeon and the patient) a primary criteria for these surgeries. (Yes, I do know that a version of this is required.) The rate of surgeries would go down, but I imagine the success rate would skyrocket.

I've noticed lots more patients are asking for the band thanks to those DTC ads the manufacturer is putting out.

K.

PS-- Incidentally, I think the driving force for the surgery in the future will be Type 2 diabetes resolution/improvement. Most data I've seen from the band suggest the effect is much less dramatic for it compared to the sleeve or GB.

Sid Schwab said...

K: Far as I know, the only adjustments they do under flouro are those in which the port is difficult to access (they have a unit in their office, as opposed to using a radiology suite.) Every patient gets a psych eval, an agrees to come to a support group post op. They treat, and get excellent results with, people of BMI in the thirties to many over sixty. Practically everyone who works there is a "bandee," including the RNs who do most of the adjustments. I hesitate to name the group here, only because I don't want to be accused of shilling for them. You could email me...

K. said...

Sid: Whoops, forgot I'd left this comment. The group I was referring to had overall results that probably underperform compared to other sites. Extenuating circumstances that had nothing to do with surgical technique likely skewed the results. Thus it's probably also skewed my perception of it as an efficacious operation.

Interesting that you have a mandatory post-op support group. I've heard more about that recently, and bet it probably would improve follow-up rates and sticking to diets.

SueW said...

Dr Sid, thank you for this excellent article... I love your honesty and excellent summation of differences between bypass and band. Will be very helpful for pre ops. We need more physicians/surgeons like yourself... consider cloning yourself...
Best,
Sue

JohnMc said...

Dr. Sid, LOTS of questions. I have recently been reading the WLS usergroup posts and there does not seem to be much agreement, about what works best. I have decided to try and have WLS and initially I had decided on a bypass, but after reading this post, I am thinking perhaps the band is better. I am not a vain person, but I don't want to age prematurely and be burdened w/ new problems a few years later. In my web browsing on the subject, I found the mini Gastro Bypass (MGB) and it appears safer, but has a shorter history. There seem to be less cutting and the bypassing of 4-6 ft of small intestine sounded good. The main reasons I DID not like the band was the need for continued adjustment, erosion, more puking, and what seemed to be less weight loss (or is it only slower). It seems that alot of the banders lost only about 100 lbs in a year and leveled off. This will not work for me. I am 400 lbs, I would still be to big w/ only a 100 lb loss. I'm 6' 3", 400 lbs, w/ a BMI of 50. Would the band get me to 200 lbs, but just take longer? I am also concerned about loose skin after the wt loss, would this be less of an issue if the loss were slower, w/ a band. I want to get to 200 lbs w/in 2-3 years. I am 49 yrs old and am currently reasonably healthy (all things concidered), BP is ok, boarderlI am concerned about my health down the road, considering my family history (strokes, heart-attacks, colon & prostate cancers, Type
ii diabeties, depression, HBP, etc.) I'm a boarder-line diabetic, high colesterol (controled w/ a low dose of a statin), joints ok, have sleep apnea (but I snored at 225 lbs). Do I stand a better chance of few conplications for an RNY of MGB? My main health problem is depression; I think it causes my weight and my weight gain causes the depression. What do u think of the MGB? And why are so few surgeons doing them?

Sid Schwab said...

JohnMc: I don't know about the MGB. How much weight a person loses with any procedure has in part to do with commitment and followup. I've expressed an opinion about the choices, and I acknowledge that not everyone agrees -- by a long shot. And I work with a group that, in my opinion, provides the best care possible, which I'd guess not all do. I don't want to be in the position, other than expressing a general opinion, of recommending a specific procedure to a specific person, especially a person I don't actually know. It sounds like you have good reasons and strong commitment and therefore I'd guess you'd do well no matter what you choose.

SueW said...

re: John Mc - the MGB (for "mini gastric bypass") is another variation of the gastric bypass based on the Billroth II. Instead of the small bowel being cut in one place it is pulled up and anastomosed to the pouch (which is, last I talked to the inventor) created out of the cardia or ring of muscles at the top of the stomach. This is a variation of the older loop gastric bypass which leaves less stomach in tact than the Mason loop gastric bypass. The reason many surgeons do not do them may be that some patients do not show the quick weight loss results of the RNY gastric bypass and also there is a 25 percent chance of bile reflux in MGB patients which in an unspecified number of patients can cause a type of gastritis, reflux into the lungs etc. Because there is one less cut than in the RNY, it might be a tad safer but still does, according to what the ASBS says about ANY procedure which bypasses small bowel, run the risks of several complications and vitamin deficiencies seen in the older intestinal bypass. (2) according to several studies, the expected NET weight loss on the adjustable lap band is IDENTICAL to the gastric bypass at the 3 year post op point. i.e. in most patients, 50-60 percent of the excess weight. According to the Hebrew U study in 1993, only 7 percent of gastric bypass patients keep off all their weight and 25-30 percent of bypass patients gain it all back. However, there is a possibility that with the adjustable lap band, since the weight loss is slower, that there is much more BODYFAT loss than with the bypass wherein the patient is fasting and must cannibalize muscle and bone mass to survive during the fasting period. And with a band patient who works the tool, weight loss can continue long after the first year. There are no vitamin deficiencies with the lap band. Finally the adjusting is an advantage with the lap band - revisions are done in the doctor's office and not on the operating table as is necessary with the bypass. (any bypass) What is a "normal weight" for anyone is up for grabs. If you are healthy at 49, you may not have to even lose much weight at all. Studies show that with a loss of 10-20 percent of bodyweight, risks greatly diminish. The HAES study of USC (clinical study) also suggested that people focused on health rather than weight seem to get healthier and stay with the program better.

The Coles said...

Happy New Year, Dr. Schwab! I have three words for you though: I LOVE YOUR BOOK!!!

In this seemingly humorless world of medicine, you have managed to provide a stressed-out reader like me several reasons to smile and laugh about the idiosyncracies we are faced with everyday.

Thanks for writing this really inspiring memoir.

Sid Schwab said...

Dear Coles: Thanks!! It makes me feel great to hear that. Tell your friends.

PS: that was four words.

The Coles said...

Oops. I can't believe I missed that. How embarrassing!! Anyway, here are four more words: YOUR BOOK IS FANTASTIC!

Susan said...

Hi Dr. Schwab, I am considering the lab band surgery (the bypass scares me). I love to scuba dive, have you had any reports from divers who have had the surgery?

Thank you,
Susan

Sid Schwab said...

Susan: I'm not aware of any issues. Conversely, there have been concerns about flying, when lower pressure could make the balloon on the band expand. But it turns out it's not a problem. Unless there were lots of air in it (and steps are taken to make sure there isn't), it's not a problem. I assume the opposite concern -- getting looser during diving -- would not be a problem even if it were to occur. But I don't think it would.

cafebird51 said...

Dr. Schwab,

I started looking into weight loss surgery in July 07. I have visited with the nutritionist and behavioral medicine. My next step is the pre-op skills group. I feel the lapband is the right choice for me.

Trying to make a decision on which surgery is the right fit takes you into information overload. I've found that a lot of the support forums online have a lot of good information on personal experiences, but I've also found them to be dumping grounds for personal horror stories.

I'm 57 and I'm concerned about the long term affects of Roux Y. My PCP suggests that there is more robust data on the lap band.

Although I have a short list of comobities, I'm still in fairly decent health.

Where can I find more data on lap band for patients in my age group?

I'm concerned about port replacement, erosion, slippage. Is there a common thread that surround these complications?

Sid Schwab said...

cafebird: the complications you mention are pretty much unrelated to each other. Port replacement, which is very simple, is also pretty uncommon. Once in a while the port will begin to leak, which has no danger associated with it -- it just means the band gets loose. It's quite rare, and simple to fix, since the port is right under your skin. Erosion is much rarer still; it was more common in the early days, but the band has been modified, as have the techniques for placing it. "Slippage" is the biggest issue. It occurs in around 1 - 3% of cases. It's a misnomer, largely. Actual movement of the band to an improper position is almost never the problem: it's a matter of some people forcing in too much food, and causing dilatation of the pouch above the band. Although it's a big deal if it happens, most surgeons are able to reposition it laparoscopically, without the need either to remove it or to resort to an open operation.

Obviously, no operation for weight-loss is a simple matter, and none is perfect. It's my opinion, however, as I said, that given the much lower risk of dangerous complications, the lower cost, and the fact that it can often be done as an out-patient (where I work, it's nearly always outpatient), the band comes up on top. Any of the operations ought to be considered a last resort, however.

cafebird51 said...

Dr. Schwab,

Thank you for that information. It gives me some insight before I actually meet with the surgeon in March.

I'm hoping for all things positive.

Sincerely,

Cafe

SueW said...

Cafebird51: as for information on the lap band, try:

http://drsimpson.net

This is a bariatric surgeon who has done WLS for 25 years and now ONLY specializes in the lap band because he found in several studies, including his own, that the weight loss at the 3 year point was identical regardless of what procedure but the lap band has a fraction of the complications of the other procedures and complications seen with lap band are generally not serious.

cafebird51 said...

Dr. Schwab,
Thanks for the link. I've been reading some of the discussion on Lapbandtalk.com and I just ordered Lap band Solutions: A Partner in Weight Loss. Someone gave me Lap-Band for Life by Ariel Ortiz Lagardere, which I haven't started yet.

I'm a little nervous, as you can probably tell, more so of the unknown. But, I’m anxious to have the surgery and having energy and stamina. Right now, I’m trying to quit smoking and quite frankly … it ain’t pretty.

Thanks again, I’m really glad that I found your blog, and I appreciate any information. The surgery is expect March 08.

cafebird51 said...

Suew:

Apologies to you ... thank you for the information, I didn't realize that you had posted it.

Much appreciated.

Sid Schwab said...

cafebird: I should have mentioned this book, which some consider the "bible" of lap band, and which is written by a woman with whom I work, and who has a band of her own...

Finding Jill said...

I had RNY Gastric Bypass Surgery one year ago. I went from a size 20 to a size 2. There are no foods off-limits to me since my surgery and I eat a normal healthy diet, but smaller quantities.

Here is the link to my blog about my entire wls journey--

http://www.obesityhelp.com/member/jill23

I didn't want the lapband because I don't believe the long-term results are as good and I did not want to have to go to the doctor to get "fills" for the rest of my life. I also didn't want a foreign object around my stomach and a port under my skin. There are no long-term studies on how long that "equipment" stays good inside your body--it may need replacing after 25 years--no one knows yet. My mom and a friend of mine had the lapband. Everyone has to decide what is best for them.

I paid for my weight loss surgery out-of-pocket and the whole thing cost $25,000 including the surgeon, hospital stay at a center of excellence and anesthesia. Best money EVER spent. People spend more than that on college, a car or travel. My recovery was great. I went to Dr. Robert Brolin in Princeton, NJ. He does the lapband also, but he will not decide for you--he wants you to research and decide for yourself...

I will be reading your blog regularly--I'm glad I found it!!

Jill

cafebird51 said...

Dr. Sid,

I found a copy of the book on ebay. Thanks again.

SueW said...

The media are using diabetes (as they tell us, is caused by "obesity") to scare people into having weight loss surgery. Problem being that diabetes is caused by a gene and also if 33 percent of type II diabetics have never been fat, how will losing weight necessarily help? I personally KNOW SIX type II diabetics who are on the slim side and a couple, extremely slim and have never been fat and my FIL was slim all his life, never fat - got type II diabetes in his 40's and by his 60's had lost both his legs to the disease. Like anything there is a great deal of misunderstanding about diabetes. And to the new op gastric bypass patient, the early losses are spectacular but with most people, most of the weight lost in the first year after a gastric bypass is NOT bodyfat but muscle mass and bone mass. Less than 30 percent of what patients lose is fat. By contrast, with the lap band when the weight loss is slower, MOST of what they lose is fat. According to one study, 34 percent of gastric bypass patients regained all or most of the weight (Annals of Surgery. 244(5):734-740, November 2006.
Christou, Nicolas V. MD, PhD; Look, Didier MD; MacLean, Lloyd D. MD, PhD Abstract:
Objective: To complete a long-term (>10 years) follow-up of patients undergoing isolated roux-en-Y gastric bypass for severe obesity.)

Sid Schwab said...

Sue W: there are some logical gaps there. It's true that many diabetics are not overweight, and obviously for them surgery would never be considered. Among those with type II diabetes who ARE significantly overweight, weight loss surgery has clearly been shown to reverse the glucose intolerance. In fact, for many the need for diabetes pills disappears even before all the weight is lost. So whereas what you say is true, it doesn't mean that surgery is "overhyped" for those with refractory obesity and type II diabetes.

Also, your comments about gastric bypass are among the many reasons why I'm strongly in favor of lap-band over bypass, as I've written elsewhere in this blog.

SueW said...

Seems what long term studies we have do not necessarily suggest that. In the Swedish Obesity study, among patients from all surgical procedures.... "At the two year point, 72 percent of the diabetics appeared to be recovered but at the 10 year point, only 36 percent of the diabetics were still "disease-free"." (SOURCE: New England Journal of Medicine: Volume 351:2683-2693 December 23, 2004 Number 26 Lifestyle, Diabetes, and Cardiovascular Risk Factors 10 Years after Bariatric Surgery Lars Sjostrom, M.D., Ph.D et al).
Second the Monash U study restricted diabetics to those diagnosed less than 2 years before the study. It's well known that at that early stage, mild lifestyle changes and light exercise 5 days a week, regardless of size will keep sugar levels down. And the media MISQUOTED the reseachers. The researchers NEVER said the diabetes of any of the cohort was "CURED". They used the word "IN REMISSION". (SOURCE: http://jama.ama-assn.org/cgi/content/full/299/3/316).
Third, in our bicycle club, were 5 type II diabetics. 3 were super slim, 1 was a bit fat and 1 was very fat. But the very fat one exercised daily and watched his diet. The very fat one was the only one with well controlled sugar levels (normal A1c WITHOUT MEDICATION and he kept it that way until 13 years after diagnosis when he started to require oral medications which are still controlling him today at the 14 year point after diagnosis and he's STILL fat), the slightly fat one was on meds and had an A1c of over 8 despite keeping his weight down with controlled eating and exercising, And the 3 super slim ones were brittle... Add my FIL to the mix... had poorly controlled sugar levels despite being slim all his life and lost both his legs to diabetes. Add my friend in NY to the mix... slim all his life and not well controlled. And finally add a gent on one of my sports groups to the mix. Just got diagnosed. Watches what he eats and keeps slim AND exercises a lot and cannot control BSLs without meds as the fat diabetic I mentioned beforehand could do (who is a family member). It's hype doc, and people are having unnecessary surgery because of these (false) scare tactics. If being slim does not help the 33 percent of type II's who have never been fat, it's NOT going to help the others... not on the long run. *** "Because it's risky, it's [WLS] only appropriate for a tiny fraction of people with obesity—the sickest 1 to 2 percent. The idea that all obese people should get [WLS] surgery is insane."
Lee Kaplan, M.D., director of the Massachusetts General Hospital Weight Center in Boston in "Self MAGAZINE: 'The Miracle Weight Loss that isn't' AUG 2008 ***

Sir.Tom said...

Health experts contend that weight loss surgery is a “major surgery.” One of the most common reasons why people would like to lose weight is to enhance their physical attributes. However, it should not be the underlying motivation that they should undergo the process of weight loss surgery. http://www.besthealthmed.com/weightloss.html

Grinder007 said...

Susan WHo asked about scuba and lap band procedure. Christopher Oliver is another and Doctor/Blogger who actually had the lapband proceedure posts about the subject

at the link below or I also cut an pasted part of the entry

http://christopheroliver.blogspot.com/2007/11/scuba-diving-and-laparoscopic-gastric.html

at 13:47 2 comments Links to this post
Monday, 5 November 2007
Scuba diving and adjustable laparoscopic gastric banding

Passed the theory and first five enclosed swimming pool scuba dives for PADI open water dive course this weekend. Will do the open water referral dives to obtain the PADI open water scuba qualification next month in India.

I see there is little literature on scuba and lap banding! Jesse Ahroni book “laparoscopic adjustable gastric banding” (page 92) says there is little problem as the band is fluid filled, as long as there is just air in the band! I’m not planning to dive any deeper than 60feet. I do not think gas bloat should be a problem either. I would stop on ascent and allow any gas to escape if any problems I suppose? There does seem to be some experience on LapBand Forum which shows there is not any problems with Lap Band and Scuba Diving. Any divers out there with adjustable gastric bands let me know your experiences?

Sid Schwab said...

Thanks for the useful info.

I worked with Jessie Ahroni for a few years; it makes sense that there'd be no problem with diving. Altitude would be a theoretical issue, if there were much air in the balloon part of the band.

luccy said...
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Sid Schwab said...

Note to people who post here to promote their businesses: don't.

Robert said...
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Sid Schwab said...

Same goes for you, Robert. Go away and push your pills somewhere else.

Kelsey said...

This is a great post! You are totally right about the religious fervor that WLS gets. But I think when something is such a small niche, they tend to be protective of it. :)

Sid Schwab said...

L.S.Abroad: I guess you didn't see the warning about spam comments.

jazanthony said...
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stephanie said...
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SueW said...

Sid re: diabetes - the newest study, a small but a clinical study found that a large percentage of gastric bypass patients had "irratic blood sugar levels" after surgery causing voracious appetite soon after eating.

The researchers also found that 80 percent of the patients also had undiagnosed "glucose abnormalities" including "high blood sugar" or "low blood sugar" or both. Dr. Roslin reported on this study at the 2009 ASMBS convention, suggesting that the gastric bypass may cause a heightened insulin response due to the rapid emptying of the pouch into the small bowel.

Roslin M, et al "Abnormal glucose tolerance testing following gastric bypass" Surg Obesity Related Dis 2009; 5(3 Suppl): Abstract PL-205.


link to article on medpage

F. Belt said...

Most recently, someone from church had it done in May. She had been opposed to it a couple of years ago. Her sister was one of the first ones to have it done back in the 70's and she had to travel out of state to get it done. She had a miserable time of it and they didn't have the support systems/follow-up they have in place now. She is happy and supportive of her sister but would never do it again. She did regain the weight. The woman I know lost 80lbs between May and October and is very happy about it and said she would do it again. I only know of one woman personally who got the rubber band procedure but I don't know the outcome because I had stopped working at the hospital in which she worked as a nurse.