Monday, January 14, 2008

Of surgery and blame

There's nothing new about bariatric surgery, even in the midwestern outpost I live in (once a New Yorker, always a New Yorker!), but this front-page story in this morning's paper made me see just how mainstream it's becoming--so mainstream that health insurers here are beginning to cover it.

The good news is that the story focuses on the risks of weight-loss surgery: internal bleeding, bowel obstructions, leaks in the new pipeline, blood clots, and cardiac complications. The local hospitals that do the procedures have complication rates about the national average--between 8 and 11 percent. (I wonder how this compares with complications rates of other kinds of surgery; anyone out there know?)

What made me sick was not just the literal description of the surgery, though that was graphic and disturbing. It was the curiously familiar rhetoric that accompanied the story's generally positive view of these procedures:

". . . some doctors [say] patients are looking at the surgery as an easy solution.

'I see a lot of people who are in a miserable situation, and they 're looking for a solution, and surgery seems like an easy solution,' said Dr. Edward Livingston, a bariatric surgeon at the University of Texas Southwestern Medical School in Dallas.

'But this is a big life change. It requires a great deal of investment on the patient 's part to make it work.'"

Sound familiar? It should. Like so many other diet pills and weight-loss plans, it comes with a heaping helping of guilt and blame: You say people are miserable and are just looking for an easy solution? How dare they! They should be made to suffer.

And suffer they will, if they have bariatric surgery. If they're lucky, like the woman profiled at the top of this story, they will get to go off their meds for diabetes, sleep apnea, etc. Assuming, of course, they were on them in the first place. If they're lucky, they won't die as a result of the surgery or have complications that cause them long-term pain and disability.

And even if they are lucky, they're still likely to face buyer's remorse. "This is a lifelong commitment, and there are going to be days when you're sorry you've made this commitment," says the woman profiled in the story.

I bet. I find the word commitment to be an odd one here. What we're really talking about is a procedure that mutilates the human body, with long-term consequences like absorbing 77 percent fewer nutrients from food--for the rest of your life. That's not a commitment; it's something you endure.

But the underlying assumption, here as elsewhere, is that there's an element of choice about being obese. And that's what I find frustrating and upsetting, that our culture assumes that whenever you deviate from the cultural norms around weight, it's your fault. Whether you're obese or anorexic, you are to blame, and you are to be punished.

If I were a therapist, I'd have to ask: How does this help us? What's the secondary gain of seeing weight as a reflection of intention, behavior, and responsibility?

These are the kinds of questions that stories like this one should be asking.


Anonymous said...

There was a long essay on bariatric surgery research and complications rates at Junkfood Science:

And this article is on neurological problems that often occur after bariatric surgery:

I hope those links prove useful. Thank you for your blog.

littlem said...

"What's the secondary gain of seeing weight as a reflection of intention, behavior, and responsibility?"

My short (opinionated) answer is that America is, deep down in places we don't really speak about, a Puritanistic, Calvinistic society.

According to that view, anorexics are narcissistic and selfish for wanting control over their bodily environments, and so therefore must be punished.

The overweight are indulgent and gluttonous, which are sinful traits, lacking character, and so therefore must be punished.

These punishments must be particularly virulent for women, who must serve always,and take nothing for themselves, and think nothing of themselves, and if they do they must therefore be punished.

And it's not just men who think this. Patriarchal apologist women who buy into this are masochists who think that their suffering will be rewarded by the patriarchy. Sometimes, to a certain extent, it is. Usually more with "protection" and "attention" than anything else.

This is getting complicated, and I have no desire to be a windbag. So I'm done answering for now.

Gosh I get scared when you ask those provocative probing questions, Harriet.

observer said...

All bariatric surgery really does is induce permanent famine in the patient. Expensively. That is why the weight is lost (and any weight loss is far from being just "fat").

Now count all the ways it can go wrong right off the bat. (A good web search will easily bring them up.)

But, what about the long-term benefits? What benefits? See here:

1.) The illnesses the patient has will "go away for good".

Eh, not so fast...What is it, really, that happens (with a bit of luck) with ANY health condition the WLS patient has when the surgery takes place? Those illnesses/conditions go into starvation-triggered remission. If they go away at all.

None are "cured" and can't be. Starvation has NEVER cured anything. (Except, as Ebeneezer Scrooge might say, take care of "surplus population".)

2.) To add insult to injury, in most cases the illnesses/conditions the patient was hoping to "take care of" by undergoing WLS come back sooner or later. So, guess what happens with the "meds"? That's right, they are back in the pill box. Right along with all the meds/supplements needed to combat the deficiencies/problems brought on by the WLS!

In all too many cases, the FAT comes back, too. No matter how little the patient can eat.

3.) There is also no time limit on when all the other complications from the surgery itself can manifest themselves. There are few surgeries that need more "revision" (re-doing) than WLS.

In other words, the WLS patient is never truly "over the hump" and "safe". Even if they are one of the lucky ones.

Personally, I'd rather take a nice "nap" chained on a 'rack' with the wheels turning than go through this mutilation. And take the pills if I need them...

I'll stay healthier that way, IMHO.

Anonymous said...

Anorexia is abnormal, dangerous, against life. Fatness is normal, safe, part of life. Anorexia is unacceptable because it is an illness, not becasue it's seen as a "deviation from the norm." Fatness is considered unacceptable because the mainstream's definition of normality is wrong.

Big difference. I don't appreciate being linked with anorexics, with people who are mentally ill. Fat people are normal people. Anorexics are by definition sick.

Harriet said...

For starters, I don't consider people with anorexia to be mentally ill. They're victims of a biological illness that affects both the body and the brain. Anorexia is in DSM-IV . . . and obesity is going to be in DSM-V, most likely. Like it or not, much of the world considers them analogous, and that was the point of my post. Fat people are not considered normal by the rest of the world; in fact I could argue that anorexics are *seen* as closer to normal, given how eating disordered so much of our culture has become.

observer, I'm with you. Which is why the thought of surgeons getting their hands on children and teens just makes me want to hit someone. preferably them.

littlem, you rise to the occasion quite nicely when the questions get asked. :-)

jill, thanks for the linkies! I'm a big fan of Sandy Szwarc's blog.

Anonymous said...

I'll have to disagree on anorexia not being socially acceptable. I've suffered from anorexia for over a decade, and one of the things that I find makes it so hard to recover is that it IS socially condoned. Sure, the media likes to point out celebrities they feel have gotten too thin, but my experiences in regular society seem to indicate anorexia is generally accepted. According to the World Health Organization, I fall into the "severely underweight" category, and I weigh less now at 27 than I did at 10. Nonetheless, coworkers, classmates, and even random women in shopping mall dressing rooms regularly remark upon how "lucky" I am to be so thin, and how they wish they could lose enough weight to look like me. I never know how to respond to that kind of comment, but I do know that I do not want to be held up as something to emulate.

Rachel said...

The increasing popularity of WLS really disgusts me. I believe there are many unethical doctors acting irresponsibly by performing the surgeries en masse without due regard for the health risks, both immediate and longterm.

But what really galls me is the increasing performance of WLS on children - at Children's Hospital in Cincinnati, they're performing the surgery on 12-year-olds. It's one thing for an adult to make an ostensibly well-informed decision; it's quite another for an adult to make a life-altering decision for a child.

Anonymous said...

If they put "obesity" in the DSM-V, they are making a tragic error, IMHO. Many psychiatric medications cause serious weight gain. If a patient who was not "obese" before taking the meds becomes so, then basically, there is no way to get them into remission, ever. They are damned if they do take the drugs, and damned if they don't. Given that choice, I think you will find a lot of psychiatric patients choosing "don't," because at least then they will look "acceptable" to most people. A lot of hospitalizations and deaths and damaged relationships are going to result from that. You heard it here first.

Harriet said...

Too right, Meowser. I can relate just from my own experience with SSRIs, which caused huge weight gain for me, some of which never came off after I went off 'em. And I hate to admit it, but last year when I needed to try meds again, I told my shrink I didn't want to go back on an SSRI becauase of the weight gain. I felt like a coward saying it, but it was true.

Anonymous said...

Is there any way to write to the APA and give them that viewpoint, even though I'm not a psychiatrist? I tend to think that's the argument they would best respond to, rather than simply saying "fat is not in and of itself proof of self-destructive behavior" -- which, even if true, is still considered a fringe POV. But psychiatrists cannot deny that these drugs DO cause many people to gain weight, in many cases a lot of weight, and I'm sure they don't want to see patients refusing their meds for this reason.