What is the PIMA Paradox and what does it have to do with Weight Loss Surgery?
Writing about the surgical intervention for weight
loss turned out to be one of the most complex and intense researches I've
done! It included reading hundreds of messages from both post ops
and pre ops, studying various surgical sites, studying the Anatomy and
Physiology of the Digestive Tract so I could understand what exactly the
surgery was doing.
I did discover that few people are neutral on the concept. Many who have had the surgery are enthusiastic about it almost to the point of being zealot and did not take kindly to anyone attempting to present the surgery in a realistic view.
That being said, after studying it for a while, I realized that today's most popular surgery, the Gastric By-pass is an improvement over the earlier versions being done twenty years ago, at least comfort-wise. However, it is not without its dangers and surgeons are still very evasive when discussing whether WLS patients have a normal lifespan after surgery.
It also should be said that the adjustable band is much safer than any other type of Weight Loss surgery because no permanent injury is dealt to the stomach and/or intestine. Much of the following complications are not true of the band however, as far as retaining long term weight loss, it has been observed to provide the same rate of success as the gastric bypass provides. The Adjustable Band was approved by the FDA in 2001 and is 70 percent of all procedures done in Europe.
A tabloid recently had a story about how the stars lie about reality. An example of this phenomena is Tracy Gold who finally confessed to having both anorexia and bulimia. At the time she was on the TV show getting thinner and thinner, she lied and said she ate a lot and had no eating disorder (shades of Courtney Cox and Callista Flockhart?)
The Weight Loss surgery is being sold but not by the surgeons. It is of no small concern to surgeons and other medical professionals, that by the time patients come to the office, seeking surgery, they are totally sold on this serious life changing procedure as the only 'answer', based on unrealistic information they have obtained from media sources not known for their truthfulness. High profile figures like Roseanne and Carnie Wilson make the surgery seem like a magic wand, the fairy godmother whom so many overweight people have been dreaming about.
It is my hope that some pre ops will approach this media
before they decide and that the information presented here will help them
to decide if surgery is the best solution for them.
This is under contest. Some individuals feel it's the only way.
But the success rate of thousands of people who have combined a low fat
nutritional program and daily exercise suggests that surgery, albeit one
way, is not the only way to deal with obesity. A figure about
the success rate of non surgical treatment of obesity i.e. food restriction
plus exercise is often quoted as only a five percent success rate of keeping
the weight off. This statistic is probably as old as some of my ideas
about Weight Loss Surgery were. We do know from a survey taken in
the early 1990's that in the so called successful five percent, 95
percent exercised on a daily basis.
What is the PIMA Paradox and what does it have
to do with Weight Loss Surgery?
The PIMA Indians of Arizona are considered the most obese population
in the United States by many scientists. However, members of their
community who migrated to Mexico and are genetically the same, have no
obesity problems whatsoever. The only difference between the two communities
is lifestyle. The PIMAs of Mexico live the traditional life with
no cars, no fast food, no junk food, no TV. These PIMAs work about 22 hours
of hard labor a week, run or walk to every place they need to go, grind
their own grain, do wash laundry in the river etc. Their diet is
a low fat, high complex carb nutritional program. The PIMAs
of Arizona live the same life as do most Americans with TV, cars, fast
food and junk food. The result of this American lifestyle is a very
high rate of obesity. This suggests that environmental factors play a large
role in whether a person becomes very large or not, even if genetically
predisposed. In addition to the PIMA paradox, scientists in the last couple of
years, have observed similar lifestyle impact on obesity in the Mexican paradox,
the Philippine paradox and more.
Are there any other examples in nature of environmental
factors causing obesity?
One common example is the fact that while cats who live totally indoors and eat human food, tend to become very fat, those cats who live outdoors (or spend a lot of time outdoors), eating the traditional cat diet at least in part (i.e. mice, birds etc) do not get fat at all. Cats who reside totally outdoors tend to be on the lean side despite having a big appetite.
What other factors can cause obesity?
Scientists recently found that injecting rats with a certain virus has
an interesting effect. Normal sized rats after they get well from
the viral infection now become very obese on the same diet and exercise
which kept them at normal weight previous to infection. From this,
it is likely that there are viruses which can affect humans in a similar
manner. Many people who are very large have eating disorders.
Eating disorders are not about food but about seeking love. First
of all, a person with an eating disorder can maintain a normal weight -
Richard Simmons is an example of one person who does this. Secondly,
no tool to stop compulsive eating will 'fix' an eating disorder - counseling
is needed for this. Finally, an appreciable number of very large people
may have a damaged hypothalmus gland which sometimes results in their appetite
never shutting off. Some call this a "Satiety disorder" meaning
the person cannot become satisfied after eating a meal unless their stomachs are
physically filled up.
What are the different types of surgery done for
obesity?
The R-N-Y Gastric Bypass surgery (the procedure most
often done for weight loss) reduces the size of the stomach to a
thumb-sized pouch, thus limiting the amount of food the individual can consume
at one sitting. It also bypasses a section of small intestine where a lot
of digestion of fats, sugars and vitamins takes place. Thus, some
of the food eaten must pass through the small intestine, unable to be absorbed
because it's not digested. The unused portion of the stomach and
intestine are reconnected to the small intestine to prevent the infections
often seen in the older intestinal bypasses. The "Y" shape formed
is where the surgery got its name. How much intestine in bypassed depends
on the procedure. In a proximal gastric bypass, only about 10 inches of
small intestine are bypassed. In a distal gastric bypass, as much as 10
feet of small intestine can be bypassed but most surgeons bypass from 2-5
feet.
(There are several variations for example, the Fobi pouch leaves
the unused portion of the stomach connected to the small pouch.)
Vertical Gastric Banding is where the surgeon bands the
stomach of the patient to create a small pouch which fills up very fast.
In this surgery, no intestine is bypassed, however, it seems that the complications
are very similar to gastric bypass. Additionally, several patients have
complained about the band cutting into the stomach when the stomach expands
- this is very painful and causes many problems. VBG is done less than other surgeries
like the Gastric bypass because it has not been shown to be very effective in
maintaining weight loss in the long run.
The Duodenal Switch is a form of a more drastic gastric
bypass called a "Biliopancreatic Diversion". This surgery produces
a slightly larger stomach pouch than other gastric bypasses (about 4.5
oz) and leaves 1/4 inch of the duodenum to stop dumping syndrome.
But 60 percent of the small gut is bypassed, leaving about 6.5 feet out of the
original 20 feet, and only about 30-45 inches of common tract (where
digestive juices are supposed to mix with contents of stomach) is left -
since that part of the intestine is neither made for bile (alkaline) OR stomach
acid, it may be lucky for folks with this procedure that scientists feel most of
the digestive juices from the pancreas and liver are re-absorbed before they get
to the common tract and that the stomach thus reduced in size produces very
little in the way of stomach acid.. As can be expected,
the weight losses are even quicker with this form of the surgery because most
food eaten does not end up nourishing the body. However
several surgeons do not do the procedure often, expressing concern about long
term malnutrition being common with a BPD type surgery. 
Following is what the American Society of Bariatric Surgery says about the Biliopancreatic Diversion, including the Duodenal switch:
Extensive gastric bypass (biliopancreatic diversion). In this more complicated gastric bypass operation (figure 5), portions of the stomach are removed. The small pouch that remains is connected directly to the final segment of the small intestine, thus completely bypassing both the duodenum and jejunum. Although this procedure successfully promotes weight loss, it is not widely used because of the high risk for nutritional deficiencies.BPD and its variants are the most major procedures performed for obesity and it follows that prospective patients who wish to consider BPD should seek out experienced surgeons with life-long follow up programs.
Dr Wittgrove who did the gastric bypass on Carnie Wilson, does not do
the duodenal switch often. From the description of the BPD on his
website (the Alvarado Clinic), we
read the following:
We have performed over 400 of these operations, and have analyzed our results and outcomes over a long term. Although most patients obtain excellent weight loss, and maintain good health and nutrition, we have been concerned that some do not maintain contact with us, or follow a healthful diet and vitamin regimen, and that this may lead to serious nutritional disturbances, or the need to revise the operation. When compared to the Gastric Bypass, in our hands, this operation achieves similar weight loss, but at a higher risk of nutritional side-effects. Therefore, we recommend it only in certain specific situations, and advise against its routine performance.
In Carnie's book, GUT FEELINGS, Dr Wittgrove talked about the BPD as follows:
"The third type is the biliopancreatic diversion with the duodenal switch which is malabsorptive surgery. Most of us worry about the malnutrition that can occur after malabsorptive operations and favor the gastric bypass instead."
"The common channel was originally very short -- about 50 cm (19.7 inches or less than 2 feet). Now it's usually about 100 cm in length (39. Even so, there is not a lot of absorption capacity which leads to malnutrition in some patients."
Intestinal Bypass is the predecessor of the foregoing.
It disconnects all of the small intestine except for about 12 inches. The
disconnected intestine was commonly left 'floating' in the peritoneum so
that the surgery could be reversed after the weight was lost. But
unfortunately, the disconnected intestine harbored many infectious bacteria
and spread its bacteria systemically, causing general infection, arthritis
among other things. The modern surgeries are said to be safer than
intestinal bypasses, however, it is unknown if this is really true or not. While
the intestinal bypass, allowed the food to be digested in the stomach and
duodenum, the couple of feet of the rest of the small gut left, did not leave
room for much of the digested food to be absorbed. In today's surgeries like the
gastric bypass and DS/BPD, the actual digestion of food is disturbed and so even
though more small intestine is left, the undigested food must pass on through,
unabsorbed.
The Adjustable Band is the newest surgery and according to a
large European study, showed a similar success rate to the gastric bypass.
It is a silicon covered band which is filled with saline solution. It is
placed at the upper end of the stomach to create a pouch. Adjusting the
band is as easy as getting an injection. Complication rate is much lower than
with other WLS procedures.
What about Laparoscopic surgery?
This is a very modern technique which avoids the large incision (a BIGGIE).
It takes longer than the traditional type and is more expensive so some
insurance companies don't pay for it. The post operative
healing is greatly improved without the long incision , however, some
surgeons have stated that because the Gastric Bypass requires such a drastic
rearrangement of the G.I. tract, they don't feel they could perform as
successfully, laparoscopically because they cannot see as well as
they could in an open procedure. If you trust your surgeon, then
it's best to take his/her advice on this. (But at least, ask about
it!)
Are non - surgical alternatives available for everyone?
In theory, the answer is "yes", however, in reality, the answer might
be "no". For example a compulsive overeater who is eating due to
feeling lacking in love, might not be able to restrict food choices.
Also, it seems that for some individuals, exercising is tantamount to a
session on the rack and causes them a great deal of physical and mental
discomfort. Everyone is different. Most people who seek surgery
have tried to stick to non-surgical programs for years, on and off, and
for one reason or another, have not be able to do it. This is not
from a 'lack of willpower' at all. Nor is it from 'laziness'.
It's simply because we are all very complex beings and even the scientists
do not understand the mechanics of human nature. No one should
be judged as lesser for seeking surgery to help their weight problem -
on the contrary, they are facing a frightening and painful solution and
are courageous enough to be able to take that step.
Is the Gastric Bypass (RNY, Fobi pouch, Duodenal
Switch) reversible?
Most surgeons when asked this question by their patients will assure the patient that the RNY gastric bypass or duodenal switch (like earlier surgeries i.e. the stomach stapling - gastroplasty or the intestinal bypass) is reversible. However those seeking reversal sometimes found out differently. One four month post op patient whose body reacted poorly to the surgery rendering her bedfast, sought reversal from several surgeons. Although each physician she saw said the surgery could be reversed, none of them wanted to do it. Another woman did find a surgeon to reverse her RNY gastric bypass, however, it took six operations and today she must receive her food through a feeding tube. In considering the nature of the surgery in which the most of the stomach is cut away (discarded in the duodenal switch) and the intestines are totally re-sectioned, logic would tell us that the surgery is not really reversible. In reality, despite the promises of many surgeons, there is not much evidence that the procedure can be easily reversed. Lately, some doctors have expressed the fact that the gastric bypasses and BPDs are meant to be permanent:
JoAnn Mann, an eating disorders specialist who has treated several gastric bypass patients stated:
"This is a permanent prison, in a sense. You are choosing to make your stomach a different size. And while it is possible to go back, it is very rare and very risky. This is permanent."
From a doctor's website:
As I'm sure you are aware, outlet obstruction after vertical banded gastroplasty or any other type of gastric weight loss surgery is potentially fatal and should be treated as a medical emergency. Unfortunately, the VBG was designed to be irreversible. A portion of your stomach has been permanently removed and a plastic plug inserted which cannot be taken out.
Dr Louis Flancbaum also agreed in an interview that today's surgeries like the gastric bypass are designed to be permanent.
The Adjustable band is NOT permanent and can be easily reversed.
Will Weight Loss Surgery shorten my lifespan?
Although former procedures were quite dangerous (even the so called 'stomach stapling' of a few years ago), there is a lot of evidence that the procedures being done today will not shorten your lifespan to any less than the average American who restricts calories to keep very slim. However, the jury seems to be still out on this issue.
When Dr Wittgrove (who did the surgery on Carnie Wilson) was asked about
long time effects of the gastric bypass, he was very evasive. Since
he keeps a database of post op patients which has over 4000 names, his
evasive answer was not from lack of knowledge. He basically was saying
that a post op patient might live longer than someone who is morbidly obese
- but how much longer is evidentally still in question::
(question) Dr. Wittgrove, I really need to know about how this surgery will effect me when I am old (70, 80 and 90's) Dr. Alan Wittgrove: Hopefully you will live that long..... Dr. Alan Wittgrove: People who are morbidly obese don't have long life spans... Dr. Alan Wittgrove: Ideal body weight tables were based on actuarial data.... Dr. Alan Wittgrove: It is commonly known that people who are morbidly obese die earlier than those who are not morbidly obese.
Can Weight Loss Surgery prolong my life?
This is under contest, with the advocates saying very loudly, "Yes" and the nay Sayers telling you to prepare for your funeral. There is some evidence from scientific research that if you have diabetes type II, are at least 100 lbs over the charts and are unable to comply to lifestyle changes (daily exercise and low fat diet), the Weight Loss Surgery might prolong your life, but how many years is unclear. There are also cases of people who do not comply with lifestyle changes who live to a ripe old age anyway.
Dr
Edward Livingston, director of the University of California At Los Angeles
Bariatric Surgery program cautions us: "By
doing this surgery, you're creating a medical disease in the body. 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?"
Can Weight Loss Surgery help other physical conditions?
According to current research the answer is yes, it can. Following
is a table taken from an article appearing in a surgical journal:
| Condition | Percentage found in pre operative individuals | Percentage cured, 2 years after surgery |
| Diabetes or insulin resistance | 34 % | 85 % |
| High Blood Pressure | 26 % | 66 % |
| High Triglycerides | 40 % | 85 % |
| Sleep Apnea | 22 % in males, 1 % in females | 40 % |
| UNemployment | 65 % | 35% |
Note: lifestyle changes are becoming the first line suggested management of diabetes type II/ insulin resistance.
Note: One will maintain 'normal weight' if one follows the ADA's suggestion of 30-40 minutes aerobic exercise most days and a low fat nutritional program. This statement from the NIH does not necessarily advocate that one should take drastic measures to attain 'normal weight' before embarking on a healthy program. It should be also noted that 'normal weight' for each individual is different and seldom what the societal style dictates!NHLBI and NIDDK emphasize that both CVD and type 2 diabetes may be prevented or at least postponed by lifestyle changes that maintain normal weight and physical activity. Thus, modification of life habits is at the heart of the public health strategy for reducing rates of type 2 diabetes and its cardiovascular complications. (NIH mailing list - topic DIABETES)
Is everyone happy with the surgery?
Most people are happy with the surgery, for 1-5 years because of the rapid
weight loss, a dream come true for many obese people who have fought weight
issues all of their lives. But in the long run (over 10 years), it seems
that less people are happy with the surgery even if it has helped them to keep
their weight down. The very few long termers I've met, no longer recommend
the surgery to newbies - too many return visits to the hospital, too many
surgeries after the original and more. One person who had had an
intestinal bypass, when she was recently reversed, commented that for years she
could not see well enough at night to drive and now she's starting to see
better. Another lady I talked to, a college instructor who had a VBG in 1991 said
that the day she woke up from her reversal of the surgery was the day she
felt like her life began again. Today, she emphasizes that society
needs to have a change of heart rather than a change of body (something
I tend to agree with!) :)
Can I re-gain the weight after surgery?
This depends a lot on the procedure you have and also on you!
Remember the surgery is basically a tool to help lose the weight quickly
and to help keep it off. Statistics differ depending on whom you
are speaking to but the weight regain rate may be as high as 50 percent
after 5 years. Weight gain with the more drastic procedures like
the Duodenal Switch is less common but then, many doctors will not do the
Duodenal Switch (which is a form of the Biliopancreatic diversion surgery)
because they feel there are too many complications with this procedure.
Most surgeons say that maintaining the weight loss requires a lot of work
on the part of the patient. Many surgeons offer support groups and help
in this area. In the Hebrew University study on gastric bypass, the regain
to close to original weight was 24 percent of the patients.
Will the surgery make me look like a fashion statement?
Chances are it won't. Quick massive weight loss usually causes large amounts of loose skin (the body has not had time to adjust the skin to accommodate less body mass). Many WLS post ops start getting into the 'plastic surgery' syndrome. Usually a 'tummy tuck' is needed to rid the person of loose skin around the middle - many have loose skin and tucks elsewhere in the body and some even have liposuction and face lifts.
It should be remembered that all surgery has the potential of being dangerous. I have seen WLS post ops get through the initial surgery ok and then, have a lot of trouble and/or pain with the 'tummy tuck' (drainage for several weeks is common - sometimes bleeding occurs).
Although the surgery is supposed to be 'for health', many patients I've
seen, have it for looks as a number one. And when the looks doesn't
look like Pamela Lee, it's back to the surgeon for more. This can
get expensive and can be dangerous as well.
Will I never have to diet again after the surgery?
Sadly, although people go in with this expectation, the reality seems quite the opposite. After the initial large weight loss, it seems that many WLS patients begin gaining again (although not as rapidly as before). Talk on the mailing lists often includes 'joining Weight Watchers' or "joining OverEaters anon" or even 'taking diet pills'. In addition to having to do something they found annoying before surgery (i.e. diet) and often, having to exercise as well, WLS post ops must, for the rest of their lives, deal with the daily inconveniences of surgery such as dumping (a hypoglycemic reaction), food getting stuck in the stoma and more.
Things to check for before you sign on the dotted
line
Know which surgery you are having
Believe it or not, many surgeons refer to the gastric bypass (which includes an intestinal re-sectioning) as 'stomach stapling' because it doesn't sound so drastic. Ask for details and the surgical name of the procedure you are having!Make sure the facility you are having your surgery in, has an emergency room
Even if it's a hospital, it may not have the facilities to handle emergencies after Weight Loss Surgery and you may have to be transported to another hospital if you need emergency care. The time required to transport you may cause you an additional risk. To find out about this, ask one of the nurses working there.Make sure your surgeon does good follow-up after the surgery
If the surgeon seems rushed in talking to you or does not answer your questions adequately, this may indicate a lack of support after surgery. Because of the seriousness of Weight Loss Surgery, it's important to form a good relationship with your surgeon so that he can provide help as needed for vitamin deficiencies, additional surgeries and advice for various problems after your surgery.Check to see if your surgeon is fully qualified to perform Weight Loss Surgery
Ideally, he is a member of the American Society of Bariatric Surgeons, has done thousands of Weight Loss surgeries, keeps a database of former patients, has good support groups for post operative patients and specializes in Weight loss Surgery.Lurk in Support groups to find out how people are really doing with the surgery
If your surgeon has a support group, attend many meetings to find out how people are doing, what problems they are encountering and more. If your surgeon does not have a support group, you might consider attending support groups in other bariatric clinics. There are many support groups on the Internet. Graduate-OSSG on www.onelist.com has members who are over a year post op and will allow anyone to lurk and read. Spend several weeks reading carefully. Remember this is surgery which will change your life, which requires many lifestyle changes and which is not easy to reverse. Move slowly and carefully towards making your decision.If you have the least bit of doubt, hold off on scheduling the surgery
Most pre-op pamphlets I have read from surgeons, emphasize that if in doubt, don't! Surgery is a tool and not a magic bullet. People must be sure of what they are doing, be confident in their surgeons and go into the procedure with open eyes as to the lifestyle changes required and their expectations of weight loss and possible complications.
If I have surgery, what can I expect when I wake up from the recovery room?
Lots of pain. One person described it as making childbirth seem like a 'walk in the park'. Most doctors give you a 'morphine pump' to help control pain. During surgery (as in any major procedure), you are in danger of death from a blood clot or other surgical side effects. However, statistically, the risk of death on the table from this procedure is 1 death in every 300 surgeries. The death rate may be higher if the stats are not accurate. I have personally encountered three deaths from Weight Loss surgery which were recorded as deaths from "obesity".
Note: a couple of individuals have shared with me that their physicians used an epidural block for recovery and that this significantly reduced pain. Also pain would probably be less if the individual has the procedure done laparoscophically. Finally, if you connect with one of the Internet support groups, you may be able to meet an 'angel' in your area who will spend time with you after surgery and make sure you have adequate pain management.All abdominal operations carry the risks of bleeding, infection in the incision, thrombophlebitis of legs (blood clots), lung problems (pneumonia, pulmonary embolisms), strokes or heart attacks, anesthetic complications, and blockage or obstruction of the intestine. These risks are greater in morbidly obese patients. (Website: the Pacific Institute of Surgery for Obesity)
How about three weeks after surgery?
If you have an incision, it might get infected. You might have a hernia at the incision spot as well. Healing from the procedure is difficult and sometimes you vomit a lot and are unable to hold food down. Some have complications which bring them back to the hospital for more surgery.
What side effects might happen during the first year?In addition, several problems related to this specific surgical procedure are possible, although uncommon. One of these is injury to the spleen during surgery, which could require removal of the spleen. Leakage of fluid from the stomach or intestine through the staples or sutures may occur which may result in abdominal infection; this could require additional surgery for repair and for drainage of infection. Narrowing of intestinal connections may occur, which could require a second surgery to widen the opening. (Website: the Pacific Institute of Surgery for Obesity)
Note: everyone is different. Most have some of the following, a few
have one or none of the following and some have most of the following.
Depends upon how your body responds, and various other factors. If
you absolutely can't deal with any of these, you might consider a non surgical
solution.
Anastomotic stenosis (or narrowing) is common after RNY and normally responds to endoscopic dilatation. (NOTE: this is when they stick a tube down your throat and force the hole open when it has closed or gets plugged.) It rarely needs surgery. It should not interfere with rate of weight loss in the long run, although it does of course leads to nausea and vomiting. (Dr Elliot Goodman)
One surgical site describes possible side effects and complications
from the surgery as follows:
Possible late complications related to this surgery could include peptic ulcer; intestinal obstruction due to adhesions; vitamin deficiencies or anemia from insufficient absorption of iron or vitamins, low blood proteins from malabsorption, resulting in fluid retention; hernia in the abdominal incision; temporary hair thinning due to changes in protein metabolism. Specific diet, physical activity, vitamin supplements, and medications may be recommended. (Website: the Pacific Institute of Surgery for Obesity)
Not much is known about long term side effects but studies have been positive as to the fact that many can expect to live several years after surgery. Post ops past one year often notice that weight maintenance becomes something they need to deal with. About 50 percent level off the weight loss and might even gain weight as their GI tract heals and the body somewhat adapts to the new shape of things. At this point, it might be advantageous to consider the low fat high carb nutritional programs combined with exercise which would have worked without surgery in the first place. A few individuals seem to be unable to stop losing weight. According to my research, they actually have a medication which can help with this. But psychological feelings must be dealt with. Patients are often very fearful of gaining and this makes maintenance difficult. Counseling can help with this aspect and should be sought if needed.
Some post ops of more than a year, complain about passing feelings of weakness. Vitamin deficiencies should be carefully monitored and supplements and shots given if needed.
Some rheumatologists say that there is a high risk of getting an auto-immune disorder after Weight Loss Surgery. This might show up after 15-17 years after surgery. Diseases observed in long term post ops include Arthritis, Lupus and Multiple Sclerosis.
Some people get Arthritis Dermatitis Bypass Syndrome (ADBS), 3 years post op or more. This causes severe joint pain among other things and is said to be caused by an overgrowth of bacteria in the bypassed intestine. ADBS was a common side effect of the older intestinal bypass procedures and although the gastric bypass eliminates much of the danger of that, it still is observed in some patients.
Restless Leg Syndrome - from what I understand, this is where the post op goes to bed and the legs begin shaking uncontrollably for a few minutes - some get multiple episodes a night. There is a medication which is said to control this - doctors don't know quite what causes it. It's an anti-seizure medication called "Klonopin" - this medication is not without serious side effects.
Some patients have experienced peripheral neuropathy after surgery and at least one surgeon lists this as a possible side effect. Neuropathy is like a creeping partial paralysis of the lower extremities.
Many long term post ops say that they still experience loose stools (some have several a day) and that 'dumping' if sugar is eaten continues. Some feel that the nasty side effects of sugar consumption helps them to avoid sugary foods which is a positive result.
One or two individuals have complained of problems with the staples. One individual said they had to have the RNY 're-done' due to this.
Osteoporosis is often given as a long term side effect - this is due to poor absorption of calcium in many Weight Loss post op patients.
Although many vitamins and nutrients can be successfully supplemented, there are some which must be obtained from food like phytochemicals which are only found in fruit. Fruit may cause difficulty to the post op patient because of the sugar in it.
Many post ops (RNY) are instructed by their surgeons to not donate blood because of the possible weakness afterward.
Some post ops of more than one year have elevated liver enzymes thus evidencing some liver damage.
There is some evidence that nutritional deficiencies or caloric restriction on a long term basis may weaken the immune system and also make the individual less resistant to cancer.
Since very little absorption of vitamins takes place in the intestine, the kidneys may be overworked to compensate. This might cause kidney problems later on.
Most articles I've read admit that little is known about the mechanism for weight loss through surgery or the long term side effects. The following was written by a bariatric surgeon in a publication read by doctors.
According to Pacific Institute of Surgery for Obesity, many long term side effects of the gastric bypass are unknown. They write (on their website):The success of surgery for the treatment of obesity is largely a testimony to the dismal results using medical methods in the severely obese person... Despite the widespread use of these procedures, there has been relatively little effort to understand the mechanisms underlying the weight loss that they produce. Further efforts in this regard are needed. Greenway, Frank L, MD: "Surgery for Obesity" Endocrinology and Metabolism Clinics, Vol 25: Dec 1996
What is distressing is that many people don't seem to fully explore the risks before ordering the surgery. Wooley writes:The surgical treatment of obesity is an evolving process. We are learning and modifying techniques over time, resulting in more positive outcomes for our patients. Those complications that have occurred provide us with new insights, which are used to benefit future patients. Since we don't yet have complete knowledge of long-term results, we ask to see our patients in follow-up for many years after the surgery.
"In today's climate it is naiive to expect most patients to show regard for their own health, so over-riding is their desire for weight loss. This issue has become particularly clear in the experience gained with weight loss surgeries. Many surgical candidates show a striking lack of interest in the risks. After surgery, they ignore severe and unpleasant side effects rather than allow the procedure to be undone. 'Our female patients', write Ravitch and Brolin (1979, pp 382-391), 'have been reluctant to accept the dismantling procedure, even when it was discussed in terms of SAVING THEIR LIVES.' "
Low fat diet/daily exercise |
Weight loss surgery |
| You will have lost 100 to 150 lbs | You will have lost 100 to 150 lbs |
| You will have to exercise daily to keep your weight off | You will have to exercise daily to keep your weight off |
| You will be very strong and healthy with lots of energy | You might have less energy due to inability to eat much food |
| Your metabolism will be higher than it's ever been due to muscle forming and that means you can eat more without gaining your weight back. | Your metabolism may be lower than it's ever been due to chronic starvation and that means you might not be able to eat more than 800-1000 calories a day without gaining weight |
| You will have no vitamin deficiencies | You might have B12, calcium and other vitamin deficiencies which require regular injections and/or supplements |
| You can get enough calcium if you drink 3 glasses of milk a day or the equivalent | You may have difficulty absorbing calcium and are likely at risk for osteoporosis in your fifties or sixties (like most Amercians) |
| You will have enough iron in your blood | You might have an iron deficiency |
| You can easily get pregnant and give your baby all the nutriants s/he needs to be a healthy baby. You will be healthy also. | You can easily get pregnant but might have problems supplying the baby (or yourself) with nutriants due to reduced ability to eat. |
| You will have to see your doctor about once a year for a checkup | You will probably need to be regularly monitored by your physician |
| You can enjoy a good meal and even cheat on holidays. | You may not be able to enjoy a full meal (this varies with the individual but the fear of gaining is also a factor). |
| You can have a piece (even two) of your birthday cake | You'd better skip the cake due to a danger of dumping - eat some green beans instead. |
Low fat program/ daily exercise |
Weight loss surgery |
(note: the above table is not true of the adjustable band which does not pose many of the dangers that the gastric bypasses do).
What about those who have had the surgery - do they talk about it?
Yes, in spades. YahooGroups.com (a mailing list outfit) has various support groups - you can find them by typing in "OSSG" or "WLS" in the search.
I have found the duodenal switch mailing list particularly helpful and supportive. The list unlike many others I've seen, has a family atmosphere and supports and accepts all members regardless of type of surgery as well as pre-ops and interested persons. Everyone is invited to post. Type in DUODENAL SWITCH at the search prompt at http://groups.yahoo.com to find.
Graduate-OSSG on yahoogroups.com is probably the best list to lurk. As a pre op or a newly post op, you will not be allowed to post but anyone is welcome to be a member of this list. Posting members are those who have had surgery at least 1 year ago. By lurking and reading this list, you can get a good idea of various situations encountered after surgery and how these are dealt with. The list produces about 1 digest a day. To subscribe, click on the following link:
Subscribe to Graduate-OSSG mailing list
As I said before, the only thing one can say about this is that no one seems to be neutral. Some are very much in favor of it and others are very much against it.
The following is one woman's story after an VBG in 1991. She suffered for two years and then, decided to have the procedure reversed in 1993. The author of this article is a professional writer and college instructor.
Redline (article from 'Radiance Magazine')
The following couple had Weight Loss surgery five years ago. Both are thin, both love it and are willing to help with vitamin deficiencies and questions you might have: (this is a best case scenario)
The following man had an RNY in Nov 1998 and details his experiences.
Site includes photos and excellent articles, and is updated frequently.
A must-read:
Darryl's Weight Loss Surgery Site
Here is a list of complications of weight loss surgery from Dr Rutledge's site. He offers good information on his site but caution! What he calls a 'mini gastric bypass' actually bypasses a lot of intestine. Seems the 'mini' refers to the fact that he does the surgery laparoscopically.
Complications and risks of obesity surgery from Dr Rutledge's site
The following are examples of experiences from the older surgery, the intestinal bypass:
Personal story of intestinal bypass at
the 20 year point
Personal
experience with intestinal bypass performed in the 1970's
Which celebs have had Weight Loss Surgery?
Rosanne had a gastric bypass with a Fobi pouch. According to some sources, she also had some plastic surgery (probably a tummy tuck) and some liposuction procedures done. On a recent show, Roseanne admitted she was no stranger to the surgeon's office. She said that before she was thirty, she had had liposuction, her eyes 'done' and a nose job. Carnie Wilson (of Wilson-Phillips and the Carnie Show) had an RNY gastric bypass in July of 1999. (Carnie said she had the surgery after being a guest on the Roseanne show.)
Did Oprah have Weight Loss Surgery?
As of this point, Oprah feels surgery is not for her and actually, she is not a candidate for surgery because she is only about 30 lbs over what she should be (which true, is 'morbidly obese' by Hollywood standards!). She continues to exercise regularly albeit says she's not running very fast due to knee problems. She also watches what she eats but likes her daily alcoholic drink too much to totally give up sweets. Interestingly enough, her presentation of a guest who had lost 120 lbs with a gastroplasty a few years ago, spiked a lot of interest in Weight Loss Surgery.
Oh Sue, where did you get your information?
Here is a list of books I've read on fitness and weight control over the past twenty years:
Books I've read about diet and weight control
And finally, the references for this article (partially anyway):
The research for this article included
Article by Sue Widemark (last update:
12/16/01)