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.

Civil rights

I just wrote this in a comment on another post, and thought it was worth repeating in a post all its own.

We need a civil rights movement for fat people.

Fat acceptance is great, but we need to go a step further. We need our own Rosa Parks and Martin Luther King, Jr. and Mahatma Gandhi. We need civil disobedience. We need to picket outside the offices of for-profit bariatric surgery clinics. We need to Act Up, not shut up.

We need to teach our own culture an essential lesson once more: That each and every person is a valuable human being, regardless of the color of his/her skin, intelligence, country of origin, gender, sexual attractiveness, or weight. Hell, we need our own song.

We're talking basic civil rights here. Who's on the bus?

Part 2: Obesity and insurance

Part 2 of my local paper's coverage of bariatric surgery starts like this:

If you smoked a pack of cigarettes every day for 20 years, you might develop lung cancer. Most insurers would pay for surgery and other cancer treatments without quibbling over it.

But if you gradually piled on weight, then developed diabetes or other problems from obesity, your health plan likely would not cover weight-loss surgery without a fight.


Shocking, isn't it? A medical condition insurance companies don't cover. (I'm putting aside for the moment the underlying assumptions here: obesity = medical condition/disease, obesity --> diabetes and other diseases, obesity is volitional.) How could this be, you wonder?

Alas, I don't have to wonder. Two years ago I fought with our insurance company--and lost--over its coverage of my daughter's treatments for anorexia. Because anorexia is considered a mental illness, and because our progressive-in-reputation-only state does not have mental health parity, our insurer got away with covering only a small percentage of the cost of my daughter's treatment.

Where were the incredulous newspaper stories then? Where was the hue and cry, the uproar at the injustice?

Uh-huh. I thought so.

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.

Unspeakable

is what this is. Truly. I cannot speak of it. Children being harmed, mutilated, possibly killed, all because they're considered overweight. As one of the so-called surgeons involved says, “I am very pleased that youngsters will soon be offered gastric banding. Of course this will only be in extreme cases when everything has been tried and the child just cannot lose weight...."

And why exactly does a child need to lose weight so badly that s/he must be mutilated? Where does the urgency come from, the pressing need? And just how in the world can a child give informed consent for such an operation?

I don't know which is more sickening, the fat hatred that inspires such vile acts or the profit motive that no doubt encourages these surgeries. Or the thought that someday parents who refuse such surgeries on behalf of their children may be censured or have their children removed from their care.

Where are the yellow stars?

I'm going to throw up now.


Thanks to Sandy Szwarc for posting on this. I think. I'll be having nightmares. . . .

A Big Fat Bad Idea

I don't watch reality TV. Even if I did, I would not be tempted by this recent offering from TLC. The show reportedly follows a father-and-son team who perform bariatric surgery on "obese people who have opted to undergo weight-loss surgery in an attempt to regain their lives."

And here I thought obese people had lives, even without undergoing the risky-but-oh-so-profitable procedures performed by these butchers--I mean surgeons.

The producers would have you believe that this father and son are dedicated do-gooders out to make the lives of Fat People better by surgical mutilation, we know better.

We know, for instance, that nearly 40 percent of those who underwent such surgery last year had complications within 6 months, including vomiting, diarrhea, difficulty swallowing, reflux, abdominal hernia, leaking at the surgical site between stomach and intestine, and infections of one sort or another.

We know that 7 percent of those who had the surgery had to go back to the hospital within 6 months to treat complications of the surgery.

The producers of this incredibly offensive show describe the father and son as "passionate" people "who have dedicated their professional lives to raising awareness about obesity."

Raising awareness? Um, did we need our awareness raised on this issue? Do those of us whose BMI qualifies us as overweight or obese just not realize it? Is there anyone living in America--heck, in the world--who hasn't been inundated with anti-fat propaganda and prejudice?

Captain Kirk was wrong; fat is the final frontier. And this show is one big fat bad idea.