It’s in the media, therefore it must be true!

My personal feelings on weight-loss surgery are hardly a secret and have been oft-repeated, both here and elsewhere. They are, in summation, that I do not begrudge anyone their individual rights to discrete and private decisions regarding their own bodies, but that on a political and personal level I am strongly, fiercely, vehemently opposed to weight-loss surgery. In practice this means I don’t generally end the relationship if a friend chooses to have WLS, but said friend must acknowledge that it’s just not a subject we can discuss. I try to think of it as the kind of basic philosophical disagreements I can have with a given person and yet overlook, because I like that person and their friendship is more important to me than agreeing on everything, which is unreasonable anyway (as an alternative example, evidently I also have friends who disagree with me that pistachio ice cream is a grotesque concoction of Satan, and yet we manage to push past that as well).

On a personal note, WLS freaks me out. The concrete facts of it freak me out, whether it’s sealing off a teeny tiny stomach-pouch and reconnecting it on an express route some distance down one’s small intestine, or even sticking an inflatable donut around the stomach to choke part of it off. It freaks me out. My digestive system WORKS! It works! Why would I take something that works and mindfully fuck it up? I have an almost panic-response to it, which makes it extremely difficult, if not impossible, for me to understand why anyone in full possession of the facts (as everyone I’ve known who’s gone the WLS route has been) could do that to their body.

So it goes without saying that this article’s opening horror-story of WLS gone wrong gave me the shivers: The miracle weight loss that isn’t: Risks of gastric-bypass surgery are often underplayed, some experts say

The article is from Self magazine, on the web by way of msnbc.com, and is unusually critical of WLS considering the obesity panic that typically permeates the news media.

[D]espite the growing popularity of obesity surgery — and the general perception that it’s a shortcut to thinness and good health — it’s no easy path. The American Society for Metabolic & Bariatric Surgery (ASMBS) in Gainesville, Florida, puts gastric-bypass surgery’s death rate at between 1 in 1,000 and 1 in 200. In one AHRQ study, 4 in 10 patients developed complications within the first six months, including vomiting, diarrhea, infections, hernias and respiratory failure. Up to 40 percent of gastric-bypass patients can suffer nutritional deficiency, potentially resulting in anemia and osteoporosis; seizures and paralysis have been reported in extreme cases. Some of these malnourished patients experience bizarre neurological problems, as Wells did. [Emphasis added]

Whoa whoa whoa, hold up there a minute, article! Between 1 in 1,000 and 1 in 200? Does that strike anyone else as being kind of a broad freaking range of potentialities? Is that not a pretty horrifying reminder, in fact, that the exact number of casualties from WLS is totally fucking unknown? And is it not likewise horrifying to realize that doctors nationwide are proffering WLS willy-nilly as a cure-all solution for their fat patients who suffer from basically any health condition, weight-related or not?

Does this make anyone else want to roar like a big fat intestinally-intact lion?

All this for a surgery that the experts admit is poorly understood. Few randomized, controlled studies (the gold standard of research) have been performed comparing gastric bypass with nonsurgical weight loss therapy. Although initial weight loss can be dramatic — gastric-bypass patients typically shed around 70 percent of excess weight — patients gradually regain 20 to 25 percent of what they lose. For people with extreme obesity, defined as having a body-mass index of 40 or greater, gastric bypass often merely shifts them into the obese category. […] Altogether, weight loss surgery remains an uncertain proposition, and although potential patients must meet certain criteria (as the women interviewed for this article did), experts caution that the surgery is definitely not meant for the mainstream. “Because it’s risky, it’s only appropriate for a tiny fraction of people with obesity — the sickest 1 to 2 percent,” Dr. Kaplan says. “The idea that all obese people should get surgery is insane.” Yet that’s the way weight loss surgery is being peddled to the public.

I even had it “peddled” to me, totally uninvited, apropos of nothing. For the record, fatness notwithstanding, I am an impressively healthy individual, with only one chronic condition - very mild asthma - and that is unrelated to my fat. The fact that a well-meaning medical professional suggested WLS to me, a healthy body, essentially for cosmetic reasons, illustrates in a particularly stark way how irresponsibly WLS is both portrayed and understood by the medical community. Furthermore, peddling WLS to healthy individuals on the basis that their fat MIGHT, SOMEDAY, affect their health is on a level with recommending women with the most minimal risk factors for breast cancer get their breasts removed as a precautionary measure. It takes the position: “We don’t actually fully understand how fat works or how it influences health in a direct way, and instead of trying to further that understanding, we’re going to recommend you just get the fat removed, via a gruesome procedure that will in the best of circumstances affect your ability to eat and digest food for the rest of your life and the long-term health consequences of which are largely unknown.”

I understand that, for some percentage of people who choose WLS, the choice is made out of desperation after trying to confront weight-related health issues in non-surgical ways without success. I completely understand that diets don’t work and that for some people WLS seems the last chance they’ve got. But I also feel as though trading one set of health problems for another is hardly progress.

And there’s also the fact that WLS does not result in the fabled “permanent weight loss” fairy tale so many are eager to believe.

The greatest period of weight loss is the 12 to 18 months after bariatric surgery, after which you start to see weight regain, according to Meena Shah, Ph.D., an obesity researcher at the University of Texas Southwestern Medical Center at Dallas. Her 2006 review of the controlled studies done on the issue revealed that the disease-fighting properties of both bypass and banding surgery go down as patients’ weight goes back up.

[…]

But a new theory might provide some answers about post-op weight gain, and prove that willpower has little to do with it. Researchers are now theorizing that the reason patients lose a certain amount of weight in the first place is because gastric bypass, in part by toying with hormones, somehow lowers the body’s natural set point, the weight your system is most comfortable maintaining. A patient’s hunger returns, because the body has achieved that lower set point. “The surgery changes our physiology, the way the body responds to food. It makes heavy people more like people who are naturally thin,” enthuses Dr. Kaplan, who is conducting cutting-edge research on the topic. “Understanding this as a set-point issue allows us to stop blaming the patient who doesn’t do as well, because they were just built that way. What they lose is what they lose, and they can’t expect to lose any more.”

We’ll set Dr. Kaplan’s weird circular logic aside (”WLS makes fat people like thin people, except without actually making them thin!” I’m sure that sits well with his patients). Basically, WLS is surgically-induced starvation, and as such illustrates a perfectly paradoxial problem of surviving in an advanced consumer civilization - the “problem” of too much (for more on this, see Susan Bordo’s exceptional Unbearable Weight). Conventional wisdom would erroneously blame too much food for fatness, so the solution, it would seem, is to forcibly restrict intake. Except it doesn’t work - because fat people don’t get fat exclusively from eating too much food, simply restricting food isn’t going to make fat people thin.

Unfortunately, the article glosses past the fact that more and more people are choosing to pay for WLS out of pocket, owing to insurance companies and their mysterious and unfathomable rules about who qualifies for surgery and who does not. The unspoken side effect here is that WLS often remains a viable option only for the middle and upper class fatties; those without a few grand to spend (or the ability and inclination to put the procedure on credit) are out of luck.

Overall, the entire article is pretty impressive, considering it’s coming from Self magazine, which, unless it’s recently changed, is hardly a great bastion of size acceptance. I would not have expected such a critical assessment from that source, but I’m glad to be wrong, and I wholeheartedly recommend anyone who’s even thought about WLS give it a read.