Barbaric Surgery: it doesn’t work, doesn’t help, and isn’t necessary
Trigger warning: Discusses weight loss surgery, adverse events of surgery, psychological problems, suicide, and anti-fat bias.
Following the onslaught of diet ads in the first weeks of January, it is perhaps timely that we’ve just seen a series of new publications about weight loss surgery (WLS). Tell us again how YOUR diet plan works…
But anyway, I have to thank one of my readers for telling me that she misread something I wrote about bariatric surgery, and came up with the much more appropriate barbaric surgery. And thus it shall be known forevermore. So here’s a bit of a round up in what’s happening in the world of barbaric surgery (BS, for short).
Let’s start with “doesn’t work.” An Australian team has just published a review of outcomes from gastric banding over 15 years at their bariatric surgery centre. Over that time, they operated on more than 3,000 patients — the number that was widely reported along with the results of the study. As ever, a closer look tells another story. While they may well have operated on 3,000 patients, 10-year follow-up was only available for around 700, and the much-touted 15-year follow-up applied to just 54 patients. They also had a 16-year follow-up for 14 whole people. Well, almost whole people.
Anyhow, at 15 years the mean “excess weight loss” (i.e., the amount of weight above a BMI of 25) was 47.2%. That’s right, even after going through barbaric surgery, the follow-up surgeries to fix problems (2,000 of them), the malnutrition, the psychological problems, and all that other fun stuff, many of them were still fat. Very fat.
The authors also did a systematic review of the bariatric literature with over 10 years of follow-up. For lap bands, they found seven studies (including their own) comprising an impressive 315 people. Weight loss at maximum follow-up ranged from 33% excess weight to a maximum of 60%. For bypass surgery, they identified nine studies with 582 people at maximum follow-up. Results from this more invasive and irreversible method included excess weight loss ranging from a super impressive 27% to a high of 68% — still only two-thirds of the way to a “normal” BMI. That 27% came from the only study with more than 25 years’ follow-up. Five studies looked at gastroplasty. Mean excess weight loss was around 50%, but they ranged from 62% excess weight loss to a 10% weight gain. Results!
OK, moving on to “doesn’t help.” It has long been known that most people don’t really undergo BS for their health. A 1991 study found that in patients who had lost 100 lbs following BS “patients said they would prefer to be normal weight with a major handicap (deaf, dyslexic, diabetic, legally blind, very bad acne, heart disease, one leg amputated) than to be morbidly obese. All patients said they would rather be normal weight than a morbidly obese multi-millionaire.”
More recent studies have reported similar results, including this one just published by a team in the US. They surveyed nearly 600 people seeking BS, investigated their current quality of life and included a series of scenarios to identify what they would be prepared to give up to achieve a lower weight. They concluded that over a quarter of patients would accept over a 10% risk of death to achieve their most valued weight. Only two factors had a statistically significant impact on decreased “health utilities”: (1) physical problems with work and daily life due to their weight and (2) obesity stigma. Obviously, any interaction between these two can’t be measured in this type of study. But let’s face it. Many people undergo medical mutilation to avoid the stigma of living in a fat body. It has nothing to do with health.
But perhaps the cruellest cut is that nobody will respect them after they lose the weight either, since they’ll be assumed to have taken the “easy way out,” and are therefore still greedy, lazy, and unable to control themselves. An experimental study where 73 individuals were shown before and after photos of a woman and told that she had lost weight through either diet and exercise or else through barbaric surgery found that presumptions of greediness and laziness associated with being fat remain if you lost the weight through surgery. Other studies have also shown that most people still think of surgery as the easy way out for people with no self control. And here’s yet another study showing that people judge previously fat, but now thin, people just as harshly as they judge still-fat people. Clearly they were flawed human beings to get themselves into that condition in the first place!
So perhaps it isn’t entirely surprising that a recently published systematic review of completed suicides following BS confirmed what had been suspected — that the rates were much higher than in the general population. The review didn’t look at attempted suicides. Most of the included studies did not discuss reasons for suicides, but — in a case of stating the bleeding obvious — psychiatric problems were frequently cited. The authors also noted higher rates of alcoholism/liver failure, drug overdoses, and death by car accident in this population. It’s also well known that psychological problems increase with increasing BMI. There’s been some debate as to whether depressed people “let themselves go” and become fat, or fat people become increasingly depressed, for whatever reason (gee, lemme think). But a 2011 review of the literature shed some light on this issue. I don’t even really need to write it, do I? We know which way this works. And now, the evidence supports it.
And all this misery, for what? I’ve written before about how unhelpful is the focus on weight, how unnecessary it is to become thin in order to become healthier. But then it isn’t really about health. The haters will never accept us, no matter what we look like, and why would we want them to? Let’s finally just live the lives we want, and stop destroying ourselves to try and win acceptance from a group of people who don’t accept us now, never will, and seem to be proud of the fact.