One more reason NOT to get bariatric surgery

Bariatric surgery--the practice of deliberately mutiliating the gastric anatomy in order to lose weight--is being pushed harder than ever these days. The latest claim: it cures Type II diabetes instantly.

Not so fast. Apparently the issue is more nuanced than that. Researchers at the University of Washington recently found that people whose fasting blood glucose levels came down after having the surgery were still spiking diabetes-level glucose levels after meals.

The money quote:

"I don't think the procedure cures whatever it is that's causing diabetes in the first place," said Arthur Chernoff, MD, chair of endocrinology at Albert Einstein Medical Center in Philadelphia, who wasn't involved in the study.

SHocking, isn't it? Fat may not be the only cause of diabetes.

In fact, the weight-diabetes link is one of doctors' strongest arguments against fat acceptance and health at every size. Bariatric surgery is very serious business--and I mean that in both senses of the word. It's a multimillion-dollar industry based on the premise that it's a good idea to take out part of your guts--forever. Once you've had the surgery, your body is unable to process nutrients the way it used to. You may or may not become thin (some people lose weight only to regain it after); you may or may not experience some of the serious complications of the surgery; you will be permanently malnourished.

And now you may not have an instant cure for Type II diabetes after all. Because the equation may be a bit more complex than fat = bad, thin = good.

Obesity problems--true and faux

An anonymous reader posed a question to me on another thread, which I thought deserved its own thread. He or she wrote:

I've been reading your blog on and off for about 8 months now. Do you ever recognize that there is an obesity problem in the States? Though I am on board with the message that 'fat' does not equal 'unhealthy,' and I am certainly opposed to pathologizing a group of people who have nothing wrong with them, I still believe there is an obesity-related health problem in this country.

In public, I feel I need to be an advocate for fat acceptance (or maybe, Health at Every Size), but I also want to find a way to acknowledge and distinguish the obesity-related health problem that does exist. I'd love to hear your thoughts about how to address this with an even hand.

I'm not an epidemiologist; I haven't done any studies on this question. I've read extensively, I've thought about it, I've talked to people. I'll tell you what I think, personally, and then I'd like to hear from other readers who may know more than me.

What I've read suggests that there is no obesity explosion in this country. That in general Americans are a little heavier than they were, say, 50 years ago. They are also a little taller. Some of what I've read suggests that these two go hand in hand. I know that there was a surge in obesity statistics about 10 years ago, when BMI cutoffs were changed overnight. People who went to sleep merely overweight woke up obese, and an alarming new statistic was born.

I've read research suggesting that weights went up in the late 1980s, after several years of the low-fat craze. Which brings me to the point here: While I don't think we can say with any certainty that people are fatter now and/or why that might be, what we do know is that we can't make them thinner. So let's set assume for a moment that yes, people are fatter now. Let's take it a step further and proclaim that this rise in weight is a Serious Health Problem (and I'm not saying it is; as others have pointed out very well, fat is not equivalent to poor health, and thin does not correlate good health).

Here's the thing: We can't change what people weigh. Some people lose weight for a short time by dieting. But 98 percent of them gain it back, and then some.

So diets don't work for adults. They don't work for children, either. School interventions are notoriously ineffective when it comes to making kids thinner.

Now let's go back to that assumption, that weight is a serious health problem. There is little to no evidence of this. There is a correlation between obesity and diabetes, but it's a correlation, not cause and effect. We don't know that obesity causes diabetes; maybe whatever malfunctioning metabolic shift causes diabetes actually causes obesity. In which case, trying to "cure" obesity would be like trying to "cure" OCD by, I don't know, strapping someone's hands to their sides so they can't obsessively wash them. It would be treating the symptom rather than the cause.

When it comes to other measures of health, the statistics don't bear out the notion that obesity is a serious health issue. In fact, Katherine Flegal's now-famous mortality study points to modest advantages to being "overweight," especially as people age.

So in answer to your question, Anonymous, no, I don't know that obesity is a serious health problem in the U.S., and neither do you, or anyone else, for that matter. We don't have enough information; we don't even really understand the information we've got. Losing weight sometimes raises people's risk of dying from cardiac disease, in fact. We just don't know.

While we don't really understand all the implications of weight, we do know that fitness is good. Eating a varied diet that includes (but isn't necessarily limited to) fresh fruits and veggies is good. Exercising (but not to the point of obsession) is good. Feeling good about yourself is good (and feeling bad about yourself is bad for you).

So until I know more, really know more, I'm going to stick to my guns on this one. Eat well. Live well. Move your body. And, most important, love yourself as you are right now. Not 20 pounds from now but today, this minute. Self-loathing--the kind that is a natural consequence of the current anti-obesity hysteria--is far worse for people than extra pounds. As far as we know.

Fat kills. Except when it doesn't.

Deaths from coronary artery disease in the U.S. went down by half between 1980 and 2000, and researchers at the University of Liverpool attribute this to positive lifestyle changes and better treatments.

Now for the bad news: Those same researchers go on to say, on no cited evidence, that the number of deaths would have been reduced even further had it not been for the rise in obesity and diabetes.

How do they know this? Well, they don't, actually. One researcher is quoted as saying, "The increase in obesity and diabetes are a wakeup call. They reflect the increasing consumption of large helpings of junk food."

Hmmm. So deaths from heart disease have decreased during the same time that rate of obesity have increased, yet obesity is still to blame. That's what I call having it both ways.

An epidemiologist could look at the same information and come to the opposite conclusion: That obesity has a protective effect when it comes to death from heart disease.

Seems like more of the same fat-is-evil ranting to me, liberally laced with assumptions and a heaping helping of bias. Mmm, mmm.