Recently studies (actually about four of them) have come out saying that the long-term data shows that overall bariatric or gastric surgery doesn’t guarantee that your health will be any better then it was when you started and that what’s really happening is that you’re trading one set of co-morbidities for another, it's just that the new set of co-morbidities are unknown.
As in many cases when things like this happen, there have been lobbying groups petitioning congress and the senate that denying people gastric or bariatric surgery is in fact denying rights or discriminatory to people of weight. In fact, a new cottage industry of lawyers has sprung up that now only fight and sue companies and insurance companies to get the procedure approved now that it's getting harder to cover.
I often think that when a medical procedure needs to start forming Advocacy groups like the OAC or a political action groups from industry associations that do lobby then the procedure needs a good looking at MORE INFORMATION HERE.
It seems that in many cases local state Medicare or Medicaid insurance have decided that they will no longer fund the surgeries due to what they say is a preponderance of evidence that it is turning out to be an non-viable or at best unproven solution in light of recent research on people five to ten years out, and that through looking at the RNY and banding the long-term side effects along the lines of malnutrition and other complications aren't worth their risk.
When state insurance decides that they won't cover a procedure then private insurance is sure to follow. That doesn't mean that all insurance is not going to cover it. My last company still does, and when I changed carriers this year I found out that my current one still does. Many providers are now moving to covering LapBand only, but now some say there is serious evidence that the LapBand can cause serious complications as well. Long term numbers on lap banding patients say that 25% or 1/4 of all Banding patients will need a further operation to correct something at some point and that ailure rates increase with time, up to 40% at 9 years.
Results Mean (range) age of the patients (male/female ratio 31:92) was 43 years (21–44). Mean (range) preoperative weight was 130 kg (92–191). Mean (range) preoperative body mass index was 49.28 kg/m2 (35.01–66.60). Patients lost to follow-up was nearly 20% at 5 years and 30% at 8 years. Major late complications (including band erosions 3.3%, slippage 6.5%, leakage 9.8%) leading to major reoperation occurred in 30 patients (24.4%). Nearly 40% of the reoperations was performed during the third year after the operation. The mean EWL at 7 years was 56% in patients with the band in place, but 46% in all patients. The failure rates increased from about 15% during years 1 to 3 to nearly 40% during years 8 and 9. The success rate declined from nearly 60% at 3 years to 35% at 8 and 9 years.
Conclusions Complications requiring reoperations are common during the third year after the operation, and almost 25% of the patients will need at least one reoperation. Mean EWL in all patients does not exceed 50% in 7 years or 40% in 9 years and failure rates increase with time, up to 40% at 9 years.
SOURCE HERE
Let me make a strong point here. This is not me saying this. I'm just repeating what I have been reading both in the US studies and in Canada where I am spending most of my time these days.
Don't hit me with any hate mail here kids I'm just calling them as I see them and providing as much source material for you all to go through as possible. This is not an opinion, this is not a feeling and it's not personal. To get really deeper on this take yourself over to Junkfood Science and go and read Sandy's recent archives and whatever she's currently writing about. She says the things I wish I could better then I ever could anyway.
This whole thing came to a head for me a few weeks ago when I got an email from a woman I used to work with many years ago who unbeknown to me became a reader here. She emailed me and then called about how she had fought in her head for years to make the decision on if she should have the surgery and finally made the decision to go ahead and then her insurance dropped the procedure, her doctor became uncomfortable recommending it based on some new data he saw, and crying on the phone she wanted to know what I thought that she should do.
What do I think a person should do when we have our first real evidential studies that seem to indicate that the risks and complications of bariatric surgery for your average obese person outweigh the benefits, and your Doctor says he doesn't think it's right for you and your insurance is using peer reviewed material to make their decision? My answer would have to be, listen to your doctor and I guess don't have the fucking operation. And I've given this same opinion out twice or three times a day to different people, both here, and on FaceBook for the last three weeks since I started drafting this post.
You can't seriously expect me to either through this blog, or in an email or phone conversation tell you to disregard your Doctor and these studies. If you trust your Doctor and your Doctor says that he's not against it per se, but against it for what he thinks is valid medical reasons then you go with what you trust. If you don't trust your doctor, what the fuck are you doing being a patient of that Doc anyway? Or get a new Doc, or a new Job that covers it.
I'm not saying that we should have SWAT teams stopping people from the operations ,but if you’re going to ask me then I'm not going to tell you to disregard a licensed medical persons advice. So please. I don't mind the contact. But don't ask me that. Ask me how I'm doing or what I know but not if you should disregard a qualified medical professional so you look good in a bathing suit. I'm not going to tell you about doing that no matter what. I may give you an opinion or some information based partially on personal experience, but the majority of my opinion is going to be based on peer-reviewed studies that look at large groups of people. The majority of the real stuff out there mitigating the studies I'm using as reference material seem to be on web pages that belong to surgeons who stand to benefit financially from having this procedure covered by insurance.
If you don't want to hear that sort of information I suggest that you not solicit my opinion on the thing. I would tell you to listen to the research or the AMA or pay a buck and read the studies on PubMed- that’s what I would say.
And stop telling me how easy it is for me to tell people this or that because I got my surgery You’re talking about me like I won the lottery or something, not like I asked a Doctor to remove more than 95% of my stomach and a good long portion of my intestines.
This is the thing right here that really put it into perspective. There is so much fucking pressure to be thin, and society treats you so fucking badly that they could come out with a study saying that in 80% of the cases a fucking alien will brutally rip through your asshole a la The Movie Alien, killing you at about the ten year mark and I guarantee you most people would still want the operation.
I remember a good friend of mine and I talking about AIDS back in the day and he made a comment to the effect of "Aids was a bitch, but on the other hand he really would like to see what he looked like in a size small business suit before he died." And it was a joke and my friend is a decent guy and he's gay so I suppose he has a right to make off color jokes about his own morbidity , but the thing is he had an eating problem and I truly think he meant that shit.
Now look, I know that as big people who have a chance at getting thin, no one wants to hear that anyone’s going to deny them the opportunity to be thin and having been on both sides of this issue I can tell you that and in my guts (or what’s left of them) I understand. I understand what the difference is in being fat versus being thin in how the world treats you. If you'll go back and read this blog you will see that one of my main goals was to present the data as it relates to what appears in the news and what I have experienced in the truest light that I can, good or bad.
And I see just now a post on TotalFark (the paid version of Fark.com) that said "Equal Opportunity" now means you have to hire your quota of fatties, and links to this article.
So I know what it's like to want to pick up a machine gun and kill all those fucks .
But this photoshop did make me laugh I hate to admit.
Oh, come on if you can't laugh you cry right?
It's hard to know what is correct, and yes, I have had my chance but let me give you an update on it which I haven't done in a while.
My teeth have never looked better, I mean they are Hollywood teeth and you want to know why? Because it turns out that the formula of calcium that I was taking was not the correct one for me, so it wasn't getting metabolized and my teeth started popping out of my head faster than those people in the novel TommyKnockers by Stephan King.
I was sitting in a dentist chair in Ontario, Canada, with a guy whose wall was covered with awards, advanced certifications and best practice statutes and a few patents telling me
"Mr. Blei I highly doubt that whatever is happening is so bad that we would have to remove all your teeth, In all my years as a dentist I've never..."
And then he looked at my X-Rays and I shit you not, I'm adding no drama, stopped mid sentence and looked at me and said-
"I'm so sorry but we can't save any of them, I mean if you had unlimited money, maybe a few but... I'm just so sorry. You’re going to need at least $17,000 in order to get back some semblance of a bite, and you have four in your lower jaw that are so bad that I need to pull them out either today or as soon as you can get some time off or you’re looking at some heavy pain, I can wait a while, but not later then the next 72 hours."
And there I was less then two days after that with no teeth left on my bottom jaw and a ticking time clock because if you don’t get something in there the whole jaw shrinks up. I'm sitting there in the guy’s office applying for a 17K loan so I can get back 45% of my bite. And mixing a gastric bypass and my lowered capacity for eating with an even lower ability to chew food properly means that my food choices (which were already limited) are now even more limited. I got a second opinion back in New York and it was the same, so I had my teeth done and then I went on a cruise and had all the food I could want and could try a million different things. I used it as an experiment because it breaks my heart to have my wife beating her ass apart trying to cook stuff for me that I have to turn away, So I go one a cruise where they feed you a billion times a day and have a billion different choices and say, I'll try what looks good and healthy and come back with a list of foods that work. I came home with one thing on that list. I can now eat over- boiled hotdogs. And don’t get me wrong- I'm actually really happy about that. I puked for 4 of the 7 nights of that trip though, because even though they look pretty these new teeth function like shit. Let’s not even bring up the fact that my bone density test shows me having osteoporosis like a fucking 70 year old post menopausal chain smoker with a milk allergy.
Let’s talk Iron baby. It's not working. I'm taking it, but again, it’s not being metabolized. I'm one blood test away from a blood transfusion. I'm Anemic and I've been taking Iron supplements, well, like a woman after Menopause ( yea, I'm noticing that the menopause comments are starting to creep in, it could be that I'm just praying my wife will have it over and done with soon. It's bad enough that I'm an American, but I'm a man too. Don't worry, she doesn't hate all Americans but once a month she hates this one. I am apparently for one to two weeks a month, personally responsible for everything George Bush has ever done in his life, the melting of the Polar Ice Caps and the Banking Crisis... I'm a fucking Left Wing Jew From New York for gods sake, we’re so liberal most Americans think that we are Communists. Suffice it to say that her PMS explains the menopause comments.)
My Vitamin D is bad; A is bad, even the B shots aren't kicking as hard as they should be. My protein level is shit except in my Urine where it shouldn't be and my white count makes me officially Immune affected due to the low numbers and the Potassium was like crap.
This isn't after not seeing my Doctor for a year or two, this is not seeing my doctor for 4 months. And it's not like they don’t have medical care here in Canada it's just that until I'm done immigrating I have to pay for it, but trust me I see Doctors when I need to, and if any of them had thought I needed a blood test I would have had it done and damn the cost.
Now let me stress I'm still not shitting on this procedure- again I feel fine, but the scary part of this is surprisingly I feel really really fine. And I mean that I feel ok- I sleep like shit but that’s normal for me, so with all that stuff going on under the hood I would have never guessed it had I not dropped in for a blood test. My energy level is great- it has to because in Canada, shoveling snow for four hours two or three times a week is the penance we pay for afflicting the world with Celine Dion and Bryan Adams. Theoretically I could continue to feel fine up until the point where I drop dead of malnutrition or break a hip due to bone loss or have a cardiac event due to low potassium and my main point here is that mostly, the majority of people don't really get it through their head that they have to be diligent about things like this forever, and even if they feel great they can still have something going on.
I think I'm one of the most careful people I know and what happened to me is that I took a break for a bit more then 90 days and during that time I had a number of very serious things go south.
Ultimately I was smart enough to make sure I had time set aside to go and see my doctor for just this reason and I'll be doing that for the rest of my life or until they find a way for me to monitor these things without my having to do a blood draw. It's still a trade off that I would still take but probably the people in OSSG gone wrong would for the most part disagree with me, and the thing about these people is that they are shunned by the community that they have created.
Weight loss chat rooms and support groups are for the most part incredibly supportive places for people who need an serious amount of support. Specifically because as we all know society isn't that supportive of people with weight problems. You'll have a better time coming into a room full of people and telling everyone you meet that you are in recovery from crack after being arrested trying to fuck your neighbors cat in the middle of third avenue then you are to tell someone at a party that you go to OA.
But those support groups aren't so very supportive if you're not happy with the outcome, or you're sick or you're dying, and these things (and this is very important) happen to the most compliant people who work with the best doctors under the best situations.
I'm not saying that Gastric Bypass or Banding is a absolute killer. What I am saying is that like any other major and radical surgery people don't all follow the same path of recovery and don't always have have a story book life.
For every one of us that goes on to run a triathlon, there's probably another person if these studies are correct who has a problem getting up off the toilet.
And it would probably be safe to say that if you took the same set of things that happens, like people getting wound infections, or people getting blood clots or having to go and have re-operations and you applied it to open heart surgery everyone would say" well it's open heart surgery moron , shit happens what do you expect , a walk through the park, be happy you're alive and if you end up dying then we gave it our best shot".
But take those same set of issues and apply it to someone trying to recover from WLS and that supportive environment shuns you and turns it into "It's not working because you're doing something wrong." And indeed there are people who do lousy aftercare, who eat stupidly who fuck themselves up.
But there are also people who do everything humanly possible to be compliant and make it work who become disabled and or dead and those people are treated like lepers by their surgeons and the WLS community that they depend on for support.
You hear stories about people misrepresenting what their actual post-surgery life is like because they are afraid to lose the support of their WLS peers and medical service folks. So maybe we should take WLS like we take open heart surgery. You do it only when the only other option is dying and you take it with the understanding that you might not in fact get better, but worse.
If someone got worse after open heart surgery you might say, well you know, they waited too long or how much do you think a body can withstand. I mean look at all the abuse this body took and it was frankly surprising that they made it this far, good try but not your fault.
And even though I'm saying right here that my experience, I still regard the surgery as positive and beneficial for me I guarantee you that a day after posting this thing I'm going to get at least 100 emails varying from people telling me that I'm fucked in the head, making the problem worse and not better and cursing my parents' loins.
If it's right or not for this surgery to be covered or not to be covered is not for me to say. What is for me to say is that I never see in the mainstream media any of the stories that I hear from people who have had this and had a negative experience . I still don't classify my experience as negative. I'm still happy with the way I look and my quality of life is pretty damn close to great.
But nothing about me indicated that I needed a blood test. Take your average person who has this operation, maybe they’re unemployed and lost their insurance (it happens), and like me they feel fine and because they don’t want to lose their house or just because they feel so fucking great not being 400 lbs anymore they think, “If I feel fine I'll stay away from the Doctors and if I feel badly I'll go”. Logic like that seems at face value to make sense, and you don’t start to feel badly apparently for a good long time and then one day your potassium goes so low you have a cardiac issue. When my Doctor called me last week he sounded like he was shitting a little. This is a guy who tells people on a daily basis that he found a tumor in their guts or their ass or what have you and he's sounding a little too nervous for my taste when he's talking to me about my bloodwork, and this isn't just a doctor, this guys a friend of mine.
My Doctor is a practicing gastroenterology Doc at one of New Yorks major teaching hospitals- he's no Shlump. And I'm asking him, "Dude you sound a little like you're shitting your pants over this." And he says.
"Yeah, well, the thing's doing what it's supposed to do but if another guy walked into my office with your bloodwork I'd be telling your wife to go get you fitted for a coffin."
What he says is that
"The operation is doing exactly what it's supposed to do. You're restricted, you're malabsorbing- you got what you asked for, it's working, doing what it's supposed to do. I'm not sure in the end that might not be the death of you, but if it is keep your mind on the fact that it killed you doing exactly what it's supposed to do and maybe think that you probably scored a few extra years and good for that, or the quality for those years were really better then you could have ever expected. "
I can own that. I can seriously face that and say "Yea if something goes really fucked up and if I do break a hip I'm probably better off than I would have been, but to all the WLS Docs out there I would say "Don't feed me and the rest of the world a fairytale about how everyone's recovery is pretty much the same and everyone pretty much lives happily ever after. We all grow younger , have better sex , the guys' genitals all grow to enormous proportions and the women age backwards twenty five years and we all live in some sort of Yeast Infection commercial where a chick in her late forties is doing the Samba on a Caribbean beach, with an 18 year old Puerto Rican stud while something the consistency of Fontina cheese is leaking out of her cooch."
That's just not what my albeit thankfully limited experience with women having yeast infections has been. And it's quite the same thing that even people who are experiencing minor to major problems make this whole thing out to be a walk through the park and even in the best of circumstances it isn't.
Maybe for some people, but the overwhelming amount of people I speak to who are 3 years or more out have issues, and they are issues that they only found out about pretty much after the honeymoon was over. Then suddenly, their Doctor who up until then had their head-shot on his web page won't return their calls because suddenly they must be non compliant because no one has problems after this. And people are so deluded by the whole thing about being thin and never wanting to have people look at you or treat them the way that they did when they were fat that the overwhelming majority of people (even those experiencing harshly negative side effects or complications) would go out and risk it all again and have a redo. Now, they have come out with that product- a non surgical option- in case you eat your fucking face out and lose your pouch or for whatever reason gain weight back, you can go and have an endoscope down your throat and tie your pouch up nice and pretty like the day you got out of surgery, and what's worse before they had that option people were going in and paying out of pocket to have the whole fucking procedure redone on the pouch that they stretched out after the first one. So now they're having a pouch made out of a pouch and I know people who are on their third fucking pouch from a pouch and when does a fucking doctor stand up and say fucking enough. Three life threatening operations and your pouch is stretched so fine that a good fart would pop your intestine out of your nose is enough. No more for you, you're done. .
That’s the scary part and that’s why if you email me and/or you call me or whatever and you ask me I'm not going to give you the yeast infection commercial version of advice.
You can ask me if I'm still happy I did it, yes. I am. But do you also know that I really really could use gaining another 25 pounds to start to look somewhat human again but honestly if I did gain those 25 pounds ..I would be freaking out so hard you might have to put me in a mental hospital. Thats how fucked up even my head is and how afraid , mortally deathly afraid that I'm going to be overweight again I am. Don't let me fool you. I talk a good game but if it came right down to it and I had a choice of being fat and happy or being thin and anally violated by a barbed wire 14 inch dildo with a rusty drill bit on the end of it weekly ...but being thin that whole time I would probably ask you what sort of lube you were going to use on me and ask you if I needed to sign a paper for you or something. THATS HOW FUCKED UP THIS INSIDIOUS THING IS!!!
The findings, published in October's Journal of the American College of Surgeons:
• One in 50 surgery patients died within 30 days. (Other studies have reported one in 200 or one in 500 die.)
• About 3% of gastric-bypass patients younger than 40 had died in the 13.6 years after the surgery, compared with 13.8% of those who did not have the surgery.
• Overall, 11.8% of gastric-bypass patients of all ages had died after 15 years, compared with 16.3% who hadn't been operated on.
"A limitation of the study is we don't know if the people who get the surgery are healthier or sicker than those who don't," says lead researcher David Flum, a gastrointestinal surgeon at University of Washington School of Medicine.
There are risks of dying during or after gastric bypass, but those who make it often get improvements in diabetes, heart disease, lung function and other medical problems and seem to live longer, he says.
Previous research that examined the risk of dying was from "the best surgeons in the country presenting their best results," Flum says. The new data included all levels of surgical experience. Patients are five times more likely to die if the surgeon has less experience, he says.
While in another study, researchers at McGill University Health Centre in Montreal compared 1,035 morbidly obese patients who had bariatric surgery, mostly gastric bypass, with 5,746 who were similarly overweight but did not have the operation. The findings in September's Annals of Surgery showed that gastric-bypass patients lost 67% of their excess weight.
In a five-year follow-up period, six people died who had the surgery (four because of the operation), compared with 350 who died in the larger group. After adjusting for the different size of the groups, researchers say bariatric patients had an 89% reduced risk of death.
"If you take obese people and invest some money in this surgery, you are going to save lives," says lead researcher Nicolas Christou, who is head of general surgery at McGill. He performs many of the gastric-bypass surgeries in Canada.
Paul Ernsberger, an opponent of bariatric surgery and an associate professor of nutrition at Case Western Reserve University School of Medicine in Cleveland, echoes Flum's concern that the patients who didn't have the surgery in these studies may have been sicker than those who did.
The studies have limitations but are important, says Samuel Klein of the Center for Human Nutrition at Washington University School of Medicine in St. Louis. "They suggest that bariatric surgery improves long-term survival in extremely obese patients, but there is an increased risk upfront."- SOURCE USA TODAY FOR ARTICLE CLICK HERE
Ernsberger in another discussion on CNN said in this SOURCE HERE
"What you see is people in the honeymoon period. So weight loss will peak at about one and a half to two years. And then people regain the weight. I've talked to many people five, 10 years after having gastric bypass, they've regained the weight, but now they're having severe side effects. The side effects are permanent, the weight loss is not."
I'll again take the liberty of quoting Junkfood Science
"It can be easy to forget that healthcare is BIG business and uses the same sales and marketing tactics of other product or services. When separating marketing from impartial health information, as the FTC criteria emphasize, the first step is to watch out for efforts to manipulate your emotions: inspirational and motivational success stories and testimonials, or frightening and threatening statements about deadly diseases for which they can offer a cure."
Transport and food policy and the importance of sustainable transport must not be overlooked 
