DebraSY

Dueling Research

In Weight-Loss Maintenance on March 29, 2011 at 11:59 am

Last night on ABC news, former director of the CDC and current ABC pontificator, Dr. Richard Besser reported that gastric bypass surgery reverses Type 2 Diabetes forever

This morning on Good Morning America, the story replayed and then in commentary, to Robin Roberts and George Stephanopoulos, Dr. Besser bemoaned how health care insurance won’t pay for bariatric surgery.  It is, after all, clearly a cure for Type 2 Diabetes.  

He doesn’t credit his source for this revelation.  His story begins, “Doctors have discovered something incredible. . .”   Ah, those ambiguous “doctors.”  And they all agree, eh?  Mmm.  As a hedge he slips in the modifier “may”:   “Gastric bypass surgery may actually reverse type 2 diabetes almost instantly.”  (What does that “may” modify — “almost instantly” or that surgery reverses diabetes?)   He goes on to interview Dr. Phil Schauer, the Director of the Bariatric and Metabolic Institute for the Cleveland Clinic (no vested interest there) who tells us that the cure is not only instant, but permanent.  “Before they leave the hospital, they will NEVER use insulin again.”  Hmmmm.  This is a miracle, indeed. 

Dr. Besser goes on to explain that “how the procedure normalizes blood sugar remains unclear.”  Then he speculates vaguely with Dr. Schauer about “incretins” and then “humanizes” the report (as journalists are supposed to do) with the story of Katy Wiley, and actual patient who once was a fat, diabetic train wreck and now claims to be “healthy, healthy, healthy!”

Diane Sawyer doesn’t tell us what Dr. Besser’s report is based on.  She introduces it as important medical news springing from “something making headlines today.”   I would guess that Dr. Besser is probably hanging his story on the statement issued by the International Diabetes Federation (IDF) yesterday at the Second World Conference on Interventional Therapies for Type 2 Diabetes in NYC.  Here’s a two-page executive summary.   The recommendation for surgery as treatment begins at subpoint 1.5:

“In addition to behavioural and medical approaches, various types of surgery on the gastrointestinal tract, originally developed to treat morbid obesity (“bariatric surgery”), constitute powerful options to ameliorate diabetes in severely obese patients, often normalising blood glucose levels, reducing or avoiding the need for medications and providing a potentially cost-effective approach to treating the disease.”

The statement goes on to downplay the risks of bariatric surgery and promote the value of offering it to all diabetic people with a BMI exceeding 35 and to some whose BMI is between 30 and 35.

Whoa!  Wasn’t it just last year at this time that the American Association of Clinical Endocrinologists (AACE) met and heard an important paper on how Bariatric Surgery may only mask the symptoms of Type 2 Diabetes?   A case report by Medical Doctors Anna Marina and Dace Trence of the University of Washington, Seattle, summarized in this news release, throws a lot of cold water on the idea that incretins are the miracle workers that Dr. Besser and Dr. Schauer portray.   Moreover, typical fasting blood glucose measurements cannot tell the whole story.   Blood glucose, after eating, in surgical survivors vascillates to dangerous extremes.  While their’s was only a case study, n = 1, Marina and Trence posited that a popular meta-analysis study that declared bariatric surgery a “cure” for diabetes was flawed and premature, and contradicted by other, empirical, studies.    

So, that was a year ago.  Is the AACE baby now gone with the IDF bathwater?  Is the optimistic Richard Besser correct that we now have the cure to Type 2 diabetes? 

If we don’t have a cure, but merely a mask, what will be the human consequences?

The final two points in the IDF document may reveal the doubts of these surgery optimists: 

  • A national registry of persons who have undergone bariatric surgery should be established in order to ensure quality patient care and to monitor both short- and long-term outcomes.
  • In order to optimise the future use of bariatric surgery as a therapeutic modality for type 2 diabetes further research is required.

I turn to you, my dear readers.  What do you make of this battle?  Especially those of you managing Type 2 diabetes.  Is the medical evidence compelling enough to lure you onto the table, under the knife?  Is gastric bypass safer than managing your diabetes other ways?  Katy Wiley is “healthy, healthy, healthy,” afterall, and I’m just a commentator from the sidelines.  Are the scientists of the IDF (as well as Richard Besser and Phil Schauer) more credible than those of the AACE (including Marina and Trence)?  Whom will you entrust with your life?

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  1. What is really being cured is the threat of declining business among bariatric surgeons. Surely, if WLS cures Type 2 diabetes, the FDA will approve surgery for people who aren’t fat… for people who are quite young… for people with a relative somewhere on their family tree who was diagnosed with diabetes type 2. Cost effective? Of course! As a result of surgery, many people will have shorter lifespans (which can be conveniently blamed on their disease), and will likely die earlier, saving lots of money for the health insurance companies.
    Gosh, who wouldn’t leap at the chance to get their healthy stomach sliced and diced, thereby giving the economy a much-needed boost?

  2. One study does not a proof make. Show me a longitudinal study, or 10, first. Let me see that others have performed the study with their group and replicated the results FIRST. Suggesting that surgery is a cure for diabetes is reckless at this point, it may raise hopes only to expose people to very serious health consequences and may very well NOT cure their diabetes in the process. All these bariatric evangelists (or insert any other magic cure/snake oil salesman) here are way too quick off the mark and it will be the people who believe them that will be hurt. Where is the responsibility in journalism? Where did these doctors leave their integrity and how to we get it back to them before someone gets hurt?

    Barb, horrified.

  3. My husband has type 2 diabetes and a BMI of 37.2, and I can tell you right now that if his doctor recommended any kind of WLS to “cure” his diabetes, he’d be looking for another doctor. From everything I’ve read, it only works as long as the patient is losing weight. Once hir weight has stabilized (or, maude forbid, weight regain starts), t2d is no longer in remission and has to be controlled again, either with diet and exercise or medication, or all 3. Because WLS is not a “cure” for t2d, all it does is put it into remission.
    The problem is that type 2 diabetics who have WLS (and their doctors) are going by fasting blood glucose and HbA1c numbers, which are misleading. Fasting numbers will be low, and HbA1c is an average of blood glucose over 3 months – so if you’ve had a lot of highs and a lot of lows, it could average out to a relatively low number that would show up as “normal”, but those highs are doing damage whether they’re recorded or not. If patients who have had WLS and are type 2 diabetics continued with their normal testing after surgery, they would see the highs and be worried (and know that they hadn’t been “cured”). Most type 2s on the lists I belong to test before every meal, and at least once after meals, sometimes twice, and before bedtime. That’s testing anywhere from 7 to 10 times a day, and being told, after WLS, that they’re “cured”, I’m betting that a lot of them would no longer test at all, so therefore wouldn’t see those highs. They know about the lows, the symptoms for low blood sugar are pretty obvious if you’ve been type 2 for any length of time (my husband always knows when he’s low, even when his blood sugar is only 65, he knows that’s low for him and he has symptoms and tests to be sure).

  4. Apparently, Sweden has a national registry to track WLS patients. Data from Sweden indicates that the so-called diabetes “cure” sometimes goes too far, leading to dangerously low levels of blood glucose.

    http://www.ncbi.nlm.nih.gov/pubmed/20730413

    Does anyone besides me find it interesting (yet not surprising) that Debra (and her commenters) provide more detailed and better critical analysis of this issue than our top national news media outlets?

    Sigh.

  5. I just love research. The following study claims safety in the title of the journal article even though its data show 30% rate of “major complications.” Hmmmm…

    http://www.ncbi.nlm.nih.gov/pubmed/21215708

  6. Nice. And even if it really was a cure–my cousin had gastric bypass a year or two ago. Now she’s got gallbladder problems and some other problem and has been in for all sorts of ultrasounds and tests. It’s just trading one problem for another.

  7. I am just wondering why everyone is so negative and condescending on here? Not only that, but you feel the need to mock Katy Wiley?!?!: [Katy Wiley, and actual patient who once was a fat, diabetic train wreck and now claims to be “healthy, healthy, healthy!”] Really Ms. Sapp-Yarwood, you really feel the need to ridicule Katy, just because she chose to have this surgery, and not “just maintain” the way you do? Kudos to you ms. Sapp-Yarwood for maintaining the way you do, I know it very difficult! But, please don’t feel the need to rip on others that choose a different path for their own, personal, medical conditions! If somebody wants to stand on their head and sing “row, row, row, your boat” to cure their own type two diabetes, let them. If it works, who cares why it works? If it doesn’t work, then they will have to try something else, but brow beating them isn’t going to help anyone with a medical condition. It seems Ms. Wiley’s medical condition has improved greatly with the procedure that she chose! I am happy for her! She is simply sharing what has happened in her life, and with her condition, if you don’t agree with it, or don’t want take the risks involved with surgery, then don’t! But don’t mock her, or the doctors that helped her! People used to think that Earth was flat, and ridiculed people like Columbus. But he sailed anyway. Then when he made it back, people like you probably said “you just didn’t sail far enough, but you will fall off the Earth when you do”. I wondered why all the negativity, then I read that “Social Justice” is your other passion… Then I knew it was a liberal thing… Asking why a liberal is negative is like asking why water is wet…. I hope and pray that you are able to maintain a healthy lifestyle, and everyone else that reads this blog, by whatever means you are able to accomplish that goal! I understand why some people are hesitant about surgery. Anybody that has has had ANY type of general anesthesia, surgery, knows that there are inherit risks, that are explained in writing, and numerous times by medical professionals, before the surgery. On top of that, I have never heard of any “guarantee” that any procedure will be successful. You must decided for yourself the risk/benefit factor. All I can tell you is that the two people I know that have had this procedure, have been very glad that they did. But I have heard of others that didn’t have the results they wanted for numerous reasons… Decide for yourself, and good luck!

    • Chris. It is apparent that my blog is not for you. I am confused as to why you subscribed to it. Perhaps you meant only to subscribe to get my reply to this post? Or perhaps you enjoy trolling. I don’t know. You should know I won’t put up with trolling for long if that’s the case. Life is too short. (“Asking why a liberal is negative is is like asking why water is wet.” I may not be the negative one, here. Or, perhaps you don’t think “snarky” is negative when it’s delivered by a conservative. Then it’s just good humor.) There are bazillions of blogs that could be your cup of tea. I wish you well in finding them. This blog is mostly size acceptance advocates and weight loss maintainers discussing current events and science with regard to body weight.

      Now, you want my response to your reaction. Please know, I have nothing against Katy Wiley. Hooray for her feeling “healthy, healthy, healthy.” However, Richard Besser portrayed her as an extreme (too good to be true?) example of success. He used her story in an irresponsible way. He used her to make the point that this is a done deal, that this operation “cures” type 2 diabetes. I have made the point and presented evidence that there is NOT universal agreement on that. As a doctor and journalist, Besser was irresponsible and his story was simplistic and insulting.

      My hope for Katy Wiley is that she is checking her blood sugar levels frequently, because that operation may not have cured her as she believes (has been led to believe). I don’t wish that on her, of course. But if you look at Vesta’s response, for example, in addition to reading the two links from the AACE conference, you’ll see that standard blood testing protocol may not be telling her the whole story.

      • Ms. Sapp-Yarwood, I assure you that I am not a “troller” (whatever that means), and found your blog totally by accident when I saw the news piece on TV and was interested. I then Googled Katy Wiley’s name to try and get more information. I found your blog, then read what you said. I was upset by what I perceived as personal, condescending, comments that I saw in your blog, aimed at Katy Wiley, for simply telling her story about the health improvements that she has had over the last two years. I will admit that I let my tinge of anger, at what I thought was an uncalled for personal attack, get the best of me. I apologize for my “Asking why a liberal is negative is is like asking why water is wet.” comment. It was not necessary to the point I was trying to make. FYI, I am far from conservative… very Libertarian.. My conservative friends think I am liberal, my liberal friends think I am conservative (I can’t win). I digress… As this is not a political forum…

        I totally agree with you that this case should not be seen as a be all, end all, for type two diabetes at this juncture. And questions on both sides of the debate need to be asked. I applaud you for your maintaining, as well as the other readers of your blog. I wish you a long healthy life, by whatever means you are able to obtain it. Please though, don’t resort to personal attacks, especially on people that are just trying deal with the same health issues that you and your readers are trying to deal with, by whatever method they choose to accomplish their health. Also, please don’t blow off the surgical method, just because you don’t agree with it. Get evidence from both sides, then make your personal decisions, and support other people’s decisions even if they are not the same as yours. Hopefully, someday there will be a “cure”, whatever it is… good luck to all of you! 🙂

      • I generally avoid quoting Wikipedia, but if any medium understands trolls, it is Wikipedia, which is plagued with them. Here’s the link.

        Hmmm. Why were you Googling Katie Wiley’s name, anyway?

        Good luck to you, too, Chris, in all your pursuits. Be well.

  8. Hey Debra, Thanks for the info on “trolls”. I don’t do enough commenting on blogs to know the term I guess. As to why I was Googling Katy’s name… She is actually my cousin, and I grew up with her…I am personally familiar with the situation.. I was looking for an on line video download of the story, or links to send her parents… You be well too Debra… Peace! 🙂

  9. Chris, I can understand why you had a negative response to my post. I wouldn’t expect you to share it with your cousin. That would be inappropriate.

    On the other hand, you may wish to click on those AACE links. You admonish me: “please don’t blow off the surgical method, just because you don’t agree with it. Get evidence from both sides . . .” That is exactly what I did that Richard Besser did not. (And, actually, let’s acknowledge that there may be more than two sides.)

    Hold your cousin in caring thoughts. I’ll add her to mine today, too. In the future, if you have opportunity, ask her how often she checks her blood. If she’s done as Vesta speculates and backed off in frequency because she’s confident she’s “cured,” then she may need some encouragement to keep an eye on her fluctuations. As you well know, Diabetes is nothing to ignore or play around with. What we don’t know, CAN hurt us.

  10. Chris, there is no one here who would wish to make fun of your cousin, and I apologize if anything I said even hinted at that. I was being sarcastic about Dr. Besser, because he should know better than to claim a cure for diabetes on such inadequate evidence. If people take him at his word, and he is wrong (which is likely, as Vesta outlined above), a lot of people would be happy to get WLS, then throw away their needles and medicines and they would as a result become extremely ill and die for no good reason.
    The remark about “train wreck” was not a dig at your cousin, even if it seems that way. It was a dig at the media who like to portray all us fat people as train wrecks, riddled with disease and blighted by short unhappy loveless lives, who would be miraculously redeemed if only we “saw the light”. Most of us are
    justifiably cynical about media/society’s oversimplifications and outright distortions of our lives.
    I too wish your cousin a happy, healthy and fulfilling life.

  11. On the plane last night, I stumbled across a short article in the New York Times regarding the safety of the lap band. In my jet lagged state, I threw it out (I kept the wrong section of the newspaper). I just did a quick Google search and came up with this:
    http://www.nytimes.com/2011/03/29/health/research/29prognosis.html?_r=1
    It’s not the article I read yesterday, but it’s similar in tenor.

    The lap band bandwagon is yet another manifestation of our need to find simple answers to a hugely difficult questions. I hope Ms. Wiley will live a long and healthy life. Personally, I would be frightened silly to have a perfectly well functioning organ of my body mutilated, but I’m not in Ms. Wiley’s shoes.

    One thing that does make me sad: how even weight is a highly politicized issue, as we can see above.

  12. Just for my own edification, I ran a Google search on the name “Katy Wiley,” and I was aghast. My link was at the top of page two, and the little blurb picked up only the train wreck sentence, as though I was saying she’s just that. You are right, Mulberry, that I was trying to comment on the journalism, not the person. But Chris was right, too. Had I been a family member, I wouldn’t have entered this fray with my mind incredibly open.

  13. As I stated, I stumbled on this blog by accident and got a bit miffed by what I thought was a condescending tone towards somebody that I knew had been wanted to take part in the news story, because of her success two years post op. Not to make any doctor’s wallet thicker. Whether that success continues days, years, or decades, nobody knows at this point. Hopefully the procedure is as successful as was advertised, but as you all have pointed out, it is unknown how long the success will continue or if there will be draw backs in the future. Hopefully not, but only time will tell. I don’t believe (anymore) that you were attempting to personally attack Katy. Honestly, I am a total layperson, and have very little knowledge about this subject. I also don’t know the doctor that completed this surgery for Katy, his reputation or skill level. I simply am not informed. I do know the Cleveland Clinic is top notch medical facility with worldwide acclaim in many areas, so I hope this doctor is accurate in his assessment. What I also know is that two years post op, Katy is still doing great! As I said, I am a total layperson and no little about the subject… Just going by what I see and what I have been told… Anyway, I am sure she (as I) would wish you all health and good judgment with your health professionals, no matter what decisions you decide are best for you and your unique situations… Most of all, be happy!

    • Thanks for stopping by, Chris. For what it’s worth, since you’ve revealed your politics, you should know you’d find a lot of like-minded co-conspirators among the size acceptance crowd. This may not be your specific rock to die on, but here’s a link to a recent post by Big Liberty at her blog where she links to more libertarian-bent size acceptance news. Libertarianism is most welcome in Size Acceptance, because there seems to be nowhere that the nanny state interferes more than with our bodies. It wants to tax our sodas to shape our bodies, send home punitive letters to parents of public school children with unacceptable BMIs, create expensive “incentive” programs for weight loss, etc.

  14. I realize this is only another data point, but it’s interesting nonetheless: It has been shown that patients with diabetes see improvement in fasting glucose and A1C tests after gastic bypass, however, glucose tolerance tests and continuous glucose monitoring demonstrates they’re still having diabetic-level glucose spikes after eating. More info here.

    For those who haven’t had one, a glucose tolerance test generally involves fasting; getting blood drawn to check your glucose level (should be low); drinking a very sweet drink; and then getting your blood drawn at regular intervals as your body process the glucose. Diabetics will spike dangerously high after drinking the drink. Non-diabetics won’t.

  15. LFP – That makes total sense to me because the problem that type 2s have is insulin resistance, which means that their cells don’t use the insulin produced effectively. WLS isn’t going to change that. What it is going to change, for a while, is how many carbs can be eaten at one meal that will be converted to glucose for the insulin to either convert to energy or store as fat (and this system is compromised in type 2 diabetes).
    So for those type 2 diabetics who’ve had WLS and can’t eat solid food at all, and have to drink protein shakes or use some sort of liquid diet, they will probably be getting more carbs (in the form of added sugars in the drinks) and ending up with post-prandial spikes. If they aren’t testing after those liquid meals, they aren’t seeing the spikes, and those spikes aren’t showing up on fasting tests or on A1c tests – thus giving a false “cure” and doing untold damage before symptoms appear (and by then, it may be too late to undo that damage). This can also be true for those who can eat solid food but can’t handle high-fiber foods after WLS (the more fiber there is in a food with carbs, the longer it takes for the carbs to be converted to glucose and the better able to handle that glucose a diabetic’s body is – more fiber means fewer post-prandial spikes). Most WLS compromises the body’s ability to digest fiber, and this is especially true of high-fiber foods.

  16. Vesta: thank you for that excellent explanation of how WLS “works” and more importantly, doesn’t work in controlling diabetes.

  17. Vesta’s comments about the post WLS diet (such as special protien shakes and fiber component) reveal an important research area that has not been carefully analyzed, namely: are the apparent improvements in insulin/glucose stability masked by the ways through which they are measured (without glucose tolerance testing, for instance), AND are the improvements related to insulin resistance (if any, in actuality) a result of drastic changes in diet enforced by physical trauma…rather than *permanent* changes in physiological function *resulting from* the surgery itself (as has been assumed in much of the prof and pop literature).

    Unfortunately, after a period of time (approximately 2 years, average, according to the following study and others), many patients seem to gradually become more and more tolerant of higher amounts of the macronutrients that resulted in dumping syndrome during the first year or two (literally made them feel horribly sick and/or nauseous with unpredictable demand for immediate toilet access, ahem). With their newfound tolerance for the foods that had been avoided and *controlled*, many patients are then left with significantly increased hunger responses, which they then must attempt to control through “will power”. (O no! O yes.)

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3040931/

    Since these are endocrine responses, as Debra has discussed elsewhere, patients typically find that the struggle for control (they once believed had been mastered by the WLS and their changed “lifestyles”) returns–like a demon unleashed.

    Thus, another reason that symptoms of Type 2 diabetes may not fully emerge until a couple years post op relates to the kinds of macronutrients that are increasingly more tolerated by individuals transitioning through various post WLS phases. If, for example, the patient experiences dumping syndrome in response to high carbohydrade meals, early post WLS, the individual *learns* to avoid those meals which make her sick; gradually, however, as time passes, more and more carbohydrate rich meals can be tolerated without the WLS-induced purge response. This increased tolerance leaves some patients sans purge (or purge avoidance) incentive…while simultaneously they encounter a hunger/craving drive that quickly pushes them beyond their ability to “control.”

    Thus, even a couple years post op, after experiencing feelings of complete life transformation, skyrocketing self respect and social acceptance, they must face the *battle for control* and the battle to avoid regain of weight–a battle they believed was gone forever.

    The study I cite here (above) is especially poignant, to me, because it uses grounded theory to categorize person’s responses in the form of actual statements they share–so it includes the qualitative element of research (usually omitted). They are no longer simply numbers, or “subjects”, but actual human beings with hopes, feelings and complete lives. Reading the data, you can witness (and feel empathy for) the pain and disappointment of good people. And this data was collected only (up to) two years post WLS.

    I imagine that much more could be revealed after 3, 4, 5 years, etc., post op.

    My main point, if there is just one: the perspectives on WLS (offered by popular media, professionals, and researchers alike) provide only a small and often very distorted glimpse of the people who live with the aftermath of WLS. The journalistic stories and research reports are biased and misleading. We may not have a truly clear understanding of WLS for decades, if ever. Sad.

    • Wow. Thanks, Hopeful (whom we know has her RN bona fides too), it’s a recent study, very interesting, and I’m getting through to the whole thing.

      For what it is worth, I’m printing it off and I may talk about it in the future. I don’t know whether research sometimes becomes unavailable when it gets archived at later dates. I’ve had the experience of typing in a URL that once worked for me only to find I’m blocked from seeing the full study without some credential/membership, etc. So, if anyone wants this, I suggest you print it off now, while it’s hot.

  18. I’m not a medical professional, but something is pressing me to ask why this “news” is coming so late in the day. From what little I can see (or rather, what little I have paid attention to), people are becoming more aware that WLS does not necessarily mean that people will be permanently thin. Heck, in some cases people don’t even become temporarily thin!

    So they’re coming up with something new, which it why I’m so suspicious about the timing. Surely, if diabetics having the surgery were having such miraculous results – no insulin! ever! again! – someone else would have pointed this out, even anecdotally.

    I’m not seeing respectable, say, nurses commenting on all those people who no longer needed to take insulin. From before they left hospital. (I know I keep mentioning the claims, but sheeeesh, I’d laugh if it didn’t have the potential to destroy people.)

  19. I’m just getting back from vacation, so I didn’t read this until today, but I’ve really been back and forth on this on a very personal level. I have had doctors I truly respect and trust recommend the surgery to me as a way of controlling type 2 diabetes. And I still come to the conclusion that my overall quality of life will be better maintained by a “HAES” approach to my health, rather than altering my functioning digestive system.
    My belief about gastric bypass surgery and its impacts on blood sugar have to do with some miraculous way that the body responds when its vital organs have been near-fatally damaged — the ordinary rules do not apply. I think the surgery causes the body, in all its wonders, to reverse some systems so that fat stores can be utilized, and that this has lasting effects. That fewer calories are being consumed (maybe) is a mere footnote, in my estimation. Of course, this depends on the individual. Might I avoid a fatal heart attack or stroke if I have the surgery? Maybe. Might I survive a heart attack or stroke and have many more years of high-quality life to live if I don’t have the surgery? That’s where I’m placing my bet. It’s a gamble, either way. I know my life is good now. There are things I can do to be healthier now, that take rearranging my life and putting in concerted effort, and as a side effect of these changes, I may lose a bit of weight. But mostly, I want to be strong, vital, balanced — and lean isn’t the most important thing to me.

  20. Ok, I know this blog is no longer active, but I’m going to post in the hopes that it’s not completely abandoned, because I’m utterly at a loss. I had weight loss surgery in June – my choice, not recommended to me by my doctor, but something I pursued. For the record, I had the sleeve, not the RNY. I’m sure none of you will find that less abhorrent, since it involved the complete removal of most of my stomach, rather than re-routing the digestive tract. However, at least the early studies have shown a dramatic reduction in ghrelin levels. Most patients experience a long-term (to the extent there is a “long-term” for a relatively new procedure) reduction in hunger.
    So, I understand you all think I had myself “mutilated”. But after 3 prior “successful” substantial weight losses (over 50 pounds each), which eventually resulted in the all too predictable regain, and the associated “descent into hell” Debra so eloquently describes, I was looking for another option. You might justifiably argue that my best option was simply to learn to love myself and my life the way I was. But that wasn’t working for me. I was exhausted hauling around an extra 100 pounds of weight, no longer had the energy to bike, or do half marathons, or hike. I hated myself, the way I felt, the way I looked, the clothes I had to wear, and the way I perceived myself to be treated by people. I wanted the chance to lose the weight (again!), but more importantly, a decent fighting chance of KEEPING IT OFF. And while many people do regain after weight loss surgery, most of them keep at least half their lost weight off. I’m certainly hoping to do better, but even that would be a heck of an improvement over trying to be a 3-percenter.
    I also think many of you have a biased view of the “risks” of weight loss surgery. Certainly, it’s surgery, and so has inevitable risks. But the incidence of serious complications has come WAY down. Certainly people can have gall bladder problems, but I believe that’s the case whenever you lose a large amount of weight, and these days it’s standard procedure to prescribe medications that help prevent gall bladder disease during the losing stage, and from what I read, that’s working. It may be that you’re simply better informed than I am, since I lack a source to provide me with the full text of medical journal articles. Or perhaps it’s just that you’re so convinced of the evils of this approach that you haven’t taken the time to find out.
    But frankly, I’m at a loss as to why a group of such compassionate, intelligent, open-minded women is so rabidly anti-weight loss surgery. I certainly don’t think it’s an option that should be pushed on people, but for those of us who want a fighting chance at long-term substantial weight loss, it’s pretty much all medical science has to offer at the moment, and I’m not ashamed to say I was willing to accept the potential risks – it was worth it to me. Personally, I like the chances that I’ll be able to sustain a weight I’m happy with long term without permanently skating the razor’s edge of hunger, without strapping 30 pounds of weight to my body to try to up my caloric burn in workouts, and hopefully with moderate exercise and reasonable eating habits. At least, I like my chances better than they were without the surgery.
    I find this blog to be an enormously valuable resource for me, as I have no illusions about maintenance. I’m so very grateful the content is still here. Experience has taught me that losing weight is the easy part, and I expect it to be no different after surgery. I’m willing to put in the work to figure out how to sustain my weight long term, and I appreciate everything all of you have to offer. I just wish you wouldn’t treat those of us who chose the surgical route like pitiful dupes, or worse. Perhaps you could find it in your hearts to be curious about our experiences in this journey we’re all on.

    • Hey, Beth. I may be the only one still around. At least with the old posts. The site may get roughly 100 views per day, but of random posts. Mostly the ones I reference in my final post.

      At any rate, your experience is valid.

      Many of the people here have had bad experiences, either first hand or through someone close, with WLS, and have felt betrayed by the medical system. Others are strictly philosophically opposed to it. Most of us feel WLS gets more positive press (funded by those who provide it) on average than challenging press, so we’re quick to provide a balance and challenge away. But challenging WLS as a concept or on philosophical grounds is different from actually considering the circumstances of a 3-dimensional individual, such as you.

      I can’t talk much now. Will be away for a day. But maybe when I get back, we can “talk” a bit. Just know. You are valid. Your experience is valid.

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