Thanks Allergan —

Trigger warning for discussions of weight loss surgery and weight loss research with a hefty dose of sarcasm.

Hat tip to Ivan the Great for telling me about the Walk from Obesity.

This week we have have a special guest post from a very special guest. Thanks to a generous contribution to the Make-A-Shannon-Rich Foundation from Allergan, I’ve invited Senior Director of Marketing Randy Price* to share with us some exciting news.

So, without further ado, our new evil overlords:

Allergan has a Plan for you.

No, not for you, Fat Family…

… we’ve tried selling our products to fatties, but as we stated in our 2009 annual report:

we were initially surprised by the weakness of the market and our sales of obesity intervention products, particularly the LAP-BAND® Adjustable Gastric Banding System

Sure, the bariatric business has increased considerably as we’ve seen bariatric surgical procedures increase from 13,000 annually in 1998 to churning out a projected 400,000 patients in 2010. But that’s not enough. Not nearly.

You see, here at Allergan, we routinely search for the most profitable efficacious use for our products and according to this study on the increasing rates of morbid obesity:

The aggressive and costly expansion of bariatric surgery in recent years has had no visible effect on containing morbid obesity rates in the USA.

That’s right… we gave the world the perfect diet plan and what did you do with it? Got even fatter. I mean, just look at this scary, scary chart right here:

At this rate, fatties will take over the planet by 2025. That super scary chart above is how much the obese BMI ranges have jumped in the past 20 years. And those with a BMI over 50 have made the most startling jump from making up around 0.27% of the population in 2001 all the way up to 0.42% as of 2005, a 75% increase in the fattest of the fat!

I shudder just to think of it.

Obviously, restricting fatties won’t cut it. We have to dig deeper and worker harder to spread the message that your body doesn’t know what it’s doing; but Allergan does.

Therefore, in the interest of saving the planet, we are reformulating our business model to tackle the deadly, fat-filled future we now face. And the best place to start isn’t with the fatties who have already destroyed any hope of normalcy. We know that with continued pressure, we can keep pushing that annual surgery rate from 400,000 to (fingers crossed) 1,000,000 by 2020.

In the meantime, we’d like to share Allergan’s vision of the future for you, the non-fat family:

But how do we convince thin people to sign up for a surgery with such a staggering list of acute and chronic complications?

By changing the scope of bariatric, of course!

And it all begins here, at the American Society for Metabolic & Bariatric Surgery. In 1983 by Edward E. Mason, who developed Roux-en Y gastric bypass surgery, founded the American Society for Bariatric Surgery. Clearly, Dr. Mason did not have any self-serving interest in created such an organization.

But in 2007, the ASBS made a dramatic change by adding “Metabolic” to its name, since:

…now mounting evidence suggests it may be among the most effective treatments for metabolic diseases and conditions including type 2 diabetes, hypertension, high cholesterol, non-alcoholic fatty liver disease and obstructive sleep apnea.

That’s right: suffering from obstructive sleep apnea? Think LAP-BAND®!

“But Randy,” I hear you saying, “I’m not fat. I have a BMI of 25. How can LAP-BAND® help me?”

I’m glad you asked, disembodied thin person. You see, the current president of the ASMBS is Dr. Bruce Wolfe, a researcher for Allergan. In a 2009 consensus study on weight loss surgery, Dr. Wolfe joined six other doctors with ties to some of the most promising anti-obesity pharmaceutical and device manufacturers in the world, including Amylin, Arena, Johnson & Johnson, Merck, Metabolex, Miles, Obecure, Orexigen, Regeneron, Roche, Sanofi, Shionogi, Schering Plough, Roche, Allergan, Bariatric Advantage, Scientific Intake, EnteroMedics.

This study seeks to change the discussion of bariatric surgery and fat by redefining the kind of fat that should make a person eligible for any form of bariatric surgery. This redefined fat is known as “adiposopathy” and they defined it as “pathogenic adipose tissue that is promoted by positive caloric balance, increased energy storage and sedentary lifestyle in genetically and environmentally susceptible patients.”

In other words, we want to shift the discussion away from BMI and waist circumference, and focus on a less judgmental definition of fat that can include any bodies at any sizes which may have “pathogenic fat.” Gradually, we are shifting the concept of fat from merely an aesthetic eyesore to an endocrine disease that deserves the kind of unflinching treatment of other diseases.

Within this consensus study, we outline this philosophy further, while simultaneously casting aspersions upon the doubters by answering their critiques thoroughly. For example, there are critics who say that there hasn’t been enough published scientific information warranting the use of bariatric surgery as a treatment for obesity. To that we say,

…more important than the need to better understand the intricate mechanisms as to why bariatric surgery has potential health benefits is the need to know that it does have potential health benefits for obese patients with metabolic disease.

I mean, why even try to understand the intricate beauty of science… this shit works, people, and that’s all that matters.

Likewise, critics suggest that there isn’t enough information about who benefits most from metabolic surgery. Is it for fatties only or is there a new, exciting class of customers out there, just waiting to be save:

Although the cut-off points for bariatric surgery are BMI > 40 kg/m2, or > 35 kg/m2 when associated with comorbidities, some data suggest that bariatric surgery could benefit patients with adiposopathy and BMI < 35 kg/m2, with significant improvement in metabolic diseases, such as those with T2DM. This is presumably because pathogenic adipose tissue can contribute to metabolic disease, even with only mild to modest fat weight gain, suggesting that adiposopathy might be a more rational target for treatment of the overweight patient with metabolic disease than BMI alone. However, the current data available on the metabolic benefits of bariatric surgery in patients with BMI < 35 kg/m2 are very limited. So while encouraging, more research is needed to more fully examine the spectrum of patients who might best benefit from bariatric surgical intervention.

Emphasis most certainly mine.

Yes, bariatric surgery helps fatties get thin, but even those with a BMI less than 35, even those who experience “mild to modest weight gain,” should be allowed to choose this surgery as an alternative treatment for Type 2 diabetes.

Now, this leads to a very predictable critique: aren’t there cheaper, less invasive, more effective treatments for metabolic disorder? Aren’t the risks of surgically altering my stomach worse than risks associated with obesity? We’ve already thought of that:

This is not to say that bariatric surgery is without risk. Acute morbidities occur in -5–10% of patients, and chronic complications occur as well. This is also not to say that bariatric surgery is a substitute for appropriate nutrition and physical activity, which although not often successful, are the safest and the most cost effective approach to the individual overweight patient with metabolic disease.

Now, granted, the failure rate of appropriate nutrition and physical activity is in reference to weight loss, not for the overall treatment of metabolic disease, but still… LAP-BAND® is like a weight loss Ron Popeil device: set it and forget it!

As for those risks… well, you haven’t really thought about what the future holds, have you?

Furthermore, any data regarding the absolute or relative rates of bariatric surgery morbidity and mortality must take into account the variable of time, in that surgical techniques are constantly advancing towards the relentless pursuit of improved outcomes.

So stop all that belly-aching about the long list of horrible complications because somehow, someday, we’re going to solve them! Maybe not today, maybe not tomorrow, but science is all about progress and progress is all about some time in the near future.

As you can see, Dr. Wolfe and his colleagues have taken great pains to reassure the public that metabolic surgery is safe, effective and should be available for any and all Americans. In fact, in our amended and restated bylaws (PDF), we state that the purpose of the ASMBS is to “the Corporation’s specific purposes shall be to study morbid obesity and advance the art and science of bariatric surgery.”

Yes, we’re not just surgeons shilling a gut-wrenching surgical alternative to semi-starvation, we’re artists. You might even call us starving artists!

And rest assured, the ASMBS is not staffed with pie-eyed idealists or those concerned with “ethics” or “morals.” In fact, the ASMBS Executive Council President, Dr. Wolfe, has recruited some of the best and brightest minds from Allergan to join the fight against metabolic disease. In fact, of the nine current members of the Executive Council, five have ties to Allergan (PDF of disclosures):

• President-Elect Bruce Wolfe: consultant
• Councilman-at-Large, Eric DeMaria: proctor
• Councilman-at-Large, Jamie Ponce: Teaching Honoraria and Consulting Fee
• Councilman-at-Large, Christine J. Ren Fielding: Consultant, Honoraria, Research Grant, Advisory Member
• Councilman-at-Large, Gregory Schroder: Proctor, Honoraria, Consultant

That’s not even including Integrated Health President-Elect, Laura Boyer, a consultant for Allergan.

And as the Chair-Elect of the ASMBS Corporate Council Steering Committee, I will personally be responsible for our efforts to “develop and enhance the joint strategies and efforts of bariatric surgeons, healthcare professionals and industry professionals.”

One of the most exciting strategic developments has been to join the ranks of traditionally recognized diseases in hosting an awareness-building fundraiser for obesity.

Yes, you’ve seen the Walk to Cure Diabetes, the March for Babies, the Relay for Life (cancer), Great Strides (cystic fibrosis), Walk to End Alzheimer’s, National Walk for Epilepsy, Walk for Lupus Now, Walk for Autism, and the Promise Walk for Preeclampsia, but now, in conjunction with the Obesity Action Coalition, we’d like to introduce you to the Walk from Obesity, with major sponsorships by Allergan ($25,000), Ethicon Endo-Surgery ($25,000), Bariatric Advantage ($10,000), Celebrate Bariatric Supplements ($10,000), On-Q PainBuster ($10,000), and SizeWise ($10,000).

Now, some may find it odd that the ASMBS and the OAC are joining forces, since both organizations were founded and are run by the same man: Joe Nadglowski.

And what does the OAC stand for? Well, “From advocating for People for the Ethical Treatment of Animals (PETA) to remove an offensive billboard targeting individuals with obesity to advocating for expanded access to bariatric surgery in many states, and reversing the insurance requirement of an IQ test for bariatric surgery by a major insurer, the OAC has continually stepped up to the plate when it comes to advocacy and fighting for the rights of those affected.”

That’s right, we advocate for broader access to bariatric surgery, regardless of your weight or IQ. Or as they state on their website, urging members to contact congress:

Individuals affected by obesity must have access to this comprehensive treatment approach through reasonable means and this access to care should not be hindered by undue tests or prerequisites on the part of the individual.

With these, and many other, innovative steps, Allergan ensures our place in the American medical pantheon, solving complicated diseases with simple, soul-crushing surgeries that could possibly make you even sicker without any real evidence of the long-term efficacy of our products.

Allergan, indeed, has a plan for you.

*Not really.