AARP fumbles surgery story

Via a pointer from my friend Phil Werdell, I mention AARP's June newsletter, which assures that misinformation can appear anywhere. The topic is weight-loss surgery.

Gastric bypass surgery ... can cause people to lose 80 percent or more of their excess weight. And to the surprise of many researchers, this surgery reverses type 2 diabetes in many patients — often immediately after surgery, before they begin to lose weight. Among obese patients with type 2 diabetes who undergo gastric bypass surgery, studies show that 86 percent see significant improvements in blood sugar control. In 78 percent, the signs of diabetes vanish entirely. No other treatment for this potentially deadly disease has been shown to work as well.

To say that gastric bypass "can" cause people to lose 80 percent of their excess weight sounds impressive but really isn't, since people "could" lose 100 percent of their excess weight whether they have surgery or adopt a better eating regimen by any means.

Rather than telling me what surgical patients can do, tell me what they DO do. And then let's compare that with the cost of the surgery, the long-term success rate, and the other side effects.

Meanwhile, I'm not surprised that a high percentage of people who get the surgery experience greater control of their blood sugar, but that came from better eating. I got control of my blood sugar too, going on 20 years now, and I never had the surgery.

I do not oppose the surgery. It may be the best option in extreme cases, where mortality is imminent and emergency surgical intervention is called for.

But people who ate their way into consideration for surgery will still have the same urges, and quite possibly the same spiritual hole, that they had before the surgery, which makes doesn't fix any of the attendant issues; it merely shrinks the space into which one can stuff food. That might be enough for some extreme overeaters, but they would be the minority.

Meanwhile, as Werdell wrote in a rejoinder to AARP, more than 100,000 people have gotten help for problem eating in 12 Step support groups such as Food Addicts Anonymous, Compulsive Eaters Anonymous, and Overeaters Anonymous.

Surgery is an option, but it isn't the only option. As many readers may already know, I went to rehab, to an eating disorders unit, in the early '90s, back when that was still supported by insurance, even if only in a back-door sort of way. It changed my life.

Just a couple years later, managed care had slammed that back door shut. Today, even with its significant potential downsides, the knife is the practically only option if you want insurance support to get better.



Mike,  Thank you for adding me as a member.  Your site is amazing and I have enjoyed poking around and reading your articles.  I couldn't be more happy to see such comprehensive coverage about a topic so near and dear to my heart.  I couldn't resist the urge to chime in here.  You are right on point about bariatric surgery not being a cure for the urge to overeat or the spiritual and emotional drivers for filling a "hole" with food.  To that end, I don't know of any surgical group that claims it is.  Perhaps in the early days of bariatric surgery, the whole picture was seldom considered, but as the surgery has become more popular and safer, it has also become better understood. I interviewed six surgical groups before making the decision to have my surgery, and each one mandated a comprehensive program for recovery which included therapy, nutritional counseling and support group attendance (some even recommend OA). 

My point in bringing this up is that many from the 12 step community share your thought that the surgery is “ok” only in extreme cases, but is a mistake for the rest of us.  I think it could be helpful to someone who may be considering this tool to hear that they do not have to wait until they are at death's doorstep and in extreme danger of dying to reach out for help.  Early intervention is preferable in nearly every illness, compulsive overeating included. 

It’s not that I'm an advocate for the surgery, but I do feel the need to defend it.  It is so often maligned and misunderstood, and the facts which support most people’s opinions about it are incorrect.  For example, the diabetes reversal is actually not a result of eating better, though that certainly supports continued good health.  It is the physical result of bypassing the duodenum, which is the most absorptive portion of the digestive tract.  This reversal happens before patients are even back on solid foods, and it saves many lives.  Another oft quoted reason people sway others away from the surgery is the perception that it is extraordinarily risky.  The truth is, bariatric surgery was once risky, but is now safer than routine gall bladder surgery.  With less than one death in every 1000 patients, it is also less deadly than cardiac surgery and childbirth.  Finally, it boasts a long term success rate of somewhere between 70 and 85%, depending whose statistics you read.  Overall, that beats the tar out of any other weight loss or eating disorder recovery plan out there.  Of course there is a risk of regaining the weight if one does not make permanent lifestyle changes, but this risk is even higher with other programs. 

As a stand alone, I don’t think gastric bypass is a cure-all.  But as a tool for recovery, I do think it’s a viable option for people who don’t find the complete answer elsewhere and who don’t want to look down on their loved ones from the great beyond because they felt guilty needing more than other programs offer.  We all want to wear the badge of honor that comes with conquering the weight demon without surgical intervention.  The risk for me (and others like me) is the the damage to my health that continued while I failed in that quest.  Sadly, I do feel shunned by my old OA community when I see and hear what they think of people who have this surgery.  While we may each just be “another bozo on the bus” I can tell you that not one bozo is exactly like another.  Thus, the answers are not the same for all of us.  Our answers may be rooted in similar principles, but may still look different.  I am waiting for the day when the greater 12 step community truly embraces all of its principles and traditions so people like me can continue enjoying the benefits of the fellowship without feeling like they have a dark secret.

Author and wellness innovator Michael Prager helps smart companies
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