Junkfood Science: They didn’t want the surgery, but believed it was their only chance to live

February 27, 2008

They didn’t want the surgery, but believed it was their only chance to live

So rarely does mainstream media attempt to report another view of the war on obesity, that when it does, it deserves notice. The Herald Sun obtained figures from Medicare on lap band surgeries done in Victoria and found that hundreds of people are putting their lives at risk. The popularity of the surgeries have soared — increasing 400% just since the year 2000, they report, with nearly 2,300 Victorians having lap bands last year. Each year, 500 people are left suffering painful complications.

As reporters Grant McArthur and Fay Burstin write:

Danger worries surface in fight against obesity

... Medicare figures reveal almost one in 10 patients who had lap-band surgery last year needed to have the gastric band repaired, revised or replaced. A further 374 had weight-loss surgery reversed, including lap-band surgery and stomach stapling, for reasons including misplacement of the band or other adverse effects. The procedure has become such a risk that insurance companies are refusing to insure doctors who perform it unless they pay a $50,000 excess.

A 38-year-old woman from country Victoria told the Herald Sun she almost died of complications from her surgery in December. The mother of three, who weighs 150kg, spent 11 days in intensive care with a perforated stomach, lost her spleen and had three operations to repair the damage.... “I am a positive person, but I was very angry. But I have to get over that because at least I am still alive. “I came close to dying and I don't think it is as easy as everyone says. “You do realise that there are going to be complications, but I think it is glossed over by how much weight you can lose, not what can go terribly, terribly wrong."

It is widely perceived, and widely marketed, that lap bands are completely safe, reversible and result in few complications. The reality, which sadly most patients like this young mother only come to realize after their surgeries, is that the complications far exceed what most people believe. Even the clinical trials for FDA approval of the band, conducted under ideal situations, encountered high rates of complications. In just the first 3 years post-op, Lap Band reported 89% had one or more adverse events, ranging from mild, moderate, to severe. The most common were:

· vomiting (experienced by over half)

· gastroesophageal reflux (regurgitation)

· band slippage/pouch dilatation and stoma obstruction (stomach-band outlet blockage)

· esophageal dilatation or dysmotility (the long-term effects of dysfunctioning esophagus are currently unknown)

· constipation, diarrhea

· dysphagia (difficulty swallowing)

As Lap Band reported, in their study, 25% of the patients had their bands removed during their 3-year follow-up, most after adverse events. Another one in ten needed a second surgery to fix a problem.

The Mayo Clinic reported in 2000 that 20% to 25% of gastric bypass patients develop life-threatening complications. While many consumers believe the newer, less invasive laparoscopic bypasses and lap-band procedures (which tighten a constrictive band around the stomach to make it smaller) are safer, they merely have their own “unique set of complications,” according to surgeons Shanu N. Kothari, M.D., and Harvey J. Sugerman, M.D. writing in Healthy Weight Journal. Ulcerations and the bands can erode into the stomach, which is usually are why they are not reversible or removable.

While the lap band FDA trials were looking primarily at surgical complications, nutritional complications are proving serious, such as the neurological disorder and brain damage from Wernicke’s encephalopathy. Nutritonal deficiencies have been widely reported — not surprisingly, not only because of the vomiting that afflicts every other patient (51%), but because gastric acid and pepsin and a period of time in the stomach are needed for many vitamins and nutrients to be released from foods or supplements, and intrinsic factor is needed for intestinal absorption of nutrients.

Long-term complications are increasingly worrisome, and one of the U.S. centers that have been performing bands the longest recently reported 41% of patients have second surgeries to remove them because of intolerable side effects and another third were currently wanting second surgeries to have their bands removed or get gastric bypass because the bands had resulted in inadequate weight loss. One of the first long-term studies on bandings reported that 7 years post-op, 58% of patients had had second operations, almost always to have their bands removed or converted to bypasses. The reasons were esophagitis, band erosion, pouch dilatation, leakage from the balloon, and esophageal dilatation. As surgeon and author of the study, Dr. Westling Gustavsson, M.D., at the University Hospital in Uppsala, Sweden, wrote: “Our prediction is that laparoscopic adjustable gastric banding will not stand the test of time.”

As the Herald Sun reported today, the number of medical claims resulting from lap bands far exceed those for other surgeries:

Paul Nisselle, general manager of risk assessment at Avant medical insurers, said...the number of claims “is disproportionately high for the volume of the surgery being performed, even allowing for the fact that you are starting with a risky patient pool... I am talking about situations where there has been a complication as a result of the surgery, not the patient.”

...Weight management expert Dr Rick Kausman said the number of patients coming to see him with lap-band surgery problems had doubled in the past two years.

The incessant scares about the unhealthiness of being fat has proven profitable for the weight loss and bariatric industries. It has left most fat people believing their life is endangered and they must lose weight at all costs. The sentence in the Herald Sun that deserves special note was this one:

Dr. Samantha Thomas, a medical sociologist at Monash University's Centre for Ethics in Medicine and Society found 90 percent of obese people didn't want the surgery and saw it as very much a last resort.

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