Operation for Obesity Leaves Some in Misery

[Guest guest]

If this much is admited in a major daily newspaper you can imagine how high the

total real problems associated with this type operation really are. Also note

that now the patients need vitamins. They almost assuredly needed them before

too.

 

If the body needs " fuel " the person has a desire to eat. If the body needs some

specific nutrients to survive and they are deficient, the person also has a

desire to eat.

 

If the body doen't receive sufficient vitamins and minerals and other needed

nutrients, it will produce a desire to eat even if the person is not technically

hungry and if the person eats the wrong things and doesn't get the needed

nutrients, it becomes a vicious circle and they will become obese.

 

Also a lot of obesity is caused by damage to the brain by toxic substances,

especially some pharmacueticals.

 

Frank

 

 

 

http://www.nytimes.com/2004/05/04/health/nutrition/04FAT.html?th= & pagewanted=pri\

nt & position=

 

May 4, 2004Operation for Obesity Leaves Some in MiseryBy DENISE GRADY

 

By the time Linda Culpepper found her way to the Vanderbilt University Medical

Center, she was in an alarming state. Her hair was falling out, her skin was

flaking, and her muscles had wasted so much that it was hard for her to walk.

She had frequent attacks of diarrhea, and could rarely eat without vomiting.

 

" She was a shadow of a human being, " said her daughter, Susan Gritton.

 

Dr. Gordon L. Jensen, director of the Vanderbilt Center for Human Nutrition in

Nashville, diagnosed her condition as life-threatening malnutrition, admitted

her to the hospital and ordered intravenous feeding immediately.

 

The cause of the malnutrition was complications from weight-loss surgery

performed at another hospital, specifically a gastric bypass, a procedure that

closes most of the stomach and shortens the small intestine, often leading to

weight losses of 100 pounds. That is the operation that has strikingly

transformed celebrities like Al Roker, the television weather forecaster; Carnie

Wilson, the singer; and Roseanne Barr, the comedian.

 

Successful cases like theirs, combined with a growing epidemic of obesity, have

led to soaring demand for the surgery. In 1995, just 20,000 weight-loss

operations were performed in the United States. Last year, there were 103,000,

and this year 144,000 are projected.

 

The surgery has become big business, and medical centers have been scrambling to

start programs.

 

The rapid growth worries experts like Dr. Jensen, as well as some insurers and

government officials, who fear that inexperienced surgeons and inadequate

screening and follow-up may harm patients.

 

In the last year, Dr. Jensen said, he has seen a " tremendous surge " in patients

like Ms. Culpepper who have complications from the surgery or have not been

taught how to change their eating habits to adjust to the drastic changes in

their digestive systems. Most of the patients had surgery at smaller hospitals

that were not equipped for the problems, he said, adding that he sees as many as

one such case a week.

 

A recent study suggests that the overall death rate is twice the figure of 0.5

to 1 percent that is usually cited, and higher still if a surgeon lacks

experience.

 

Researchers also express concern that the operations are being performed on

children and teenagers with scant evidence about long-term effects. In addition,

although the surgery is supposed to be limited to people who are 100 pounds or

more overweight, Dr. Jensen and other experts said some doctors had actually

encouraged obese patients who were not heavy enough to gain more weight so they

would qualify.

 

Dr. Philip Schauer, director of bariatric surgery, the technical name for

weight-loss surgery, at Magee-Womens Hospital of the University of Pittsburgh,

which has one of the largest programs in the United States, said: " There are a

lot of surgeons who are new to this field and frankly haven't had much training.

It's the biggest problem we're having right now in this field. "

 

In an interview last month, Dr. Schauer said, " I've got three patients now that

were treated by other surgeons, with major complications. "

 

To master a weight-loss operation, he added, a surgeon needs to perform it 100

times.

 

Any surgeon can perform weight-loss surgery if a hospital will allow it.

Although a professional group recommends that weight-loss surgeons meet certain

criteria, its guidelines are not binding.

 

Citing dangers and increased costs, some insurers have decided to stop covering

the operations. In February, Blue Cross Blue Shield of Florida called the

operations extremely risky, questioned their benefits and said it would stop

paying for them after this year.

 

Dr. Barry Schwartz, a vice president of the Florida plans, said: " Folks now

doing them and the hospitals doing them I think are questionable. The physicians

are increasingly folks with little experience and remarkably little training,

down to and including weekend courses. "

 

A gastric bypass usually costs $30,000, but can cost much more if serious

complications occur. The Florida insurer's spending on weight-loss surgery

nearly doubled in the last two years, to $17 million a year, and it projected

the sum to run $200 million over the next three to four years, a spokesman said.

 

In Massachusetts in February, the State Health Department convened an expert

panel to study the surgery because three patients died last year during or after

operations at different hospitals in Boston. The panel is to issue a report next

month and recommend ways to make the surgery safer.

 

The National Institutes of Health has also begun a study of the surgery. And the

professional group for doctors who perform weight-loss surgery, the American

Society for Bariatric Surgery, has begun a program to identify " centers of

excellence " for the operations, collect information on their results and use it

to help others adopt the best surgical techniques.

 

In the meantime, victims of botched operations or poor follow-up care continue

to turn up.

 

Dr. Jensen said, " One of the key things we're seeing and find quite

disconcerting is that a lot of the places where the programs are popping up

don't have the evaluation and education components in place pre- or

postoperatively. "

 

At the Tufts New England Medical Center in Boston, Dr. Scott Shikora, an obesity

surgeon, said he had seen one or two dozen patients with complications in the

past few years, referred from other centers, usually smaller hospitals. " If you

ask any major medical center, you'll hear the same story, " Dr. Shikora said.

" They are receiving patients who were mismanaged. "

 

Weight-loss operations are challenging even for the best surgeons, and the

enormously obese who seek them are often high-risk cases because of diabetes or

heart or lung problems. Because the surgery makes such drastic changes in the

digestive system, patients need extensive counseling about how to eat and take

vitamins, or they risk malnutrition or weight gain.

 

When conducted properly, Dr. Jensen said, the surgery can give patients a new

lease on life, and for many it is the only thing that works. It can restore

health, as well as appearance, quickly easing conditions like diabetes and high

blood pressure.

 

Like any surgery, it has risks. The most common serious complications include

bleeding, blood clots, bowel obstructions, hernias and severe infections from

leaks in the belly where the stomach and small intestines have been cut and

sealed or reconnected.

 

According to the National Institutes of Health, 10 to 20 percent of patients

need additional surgery for such complications, and nearly 30 percent develop

nutritional deficiencies that lead to conditions like anemia and bone loss.

 

Researchers at the University of Washington looked at the records of more than

66,000 obese people, including 3,328 who had bariatric surgery at various

hospitals from 1987 to 2001. Within 30 days of the surgery, the death rate was

1.9 percent. Patients were 4.7 times as likely to die during a surgeon's first

19 procedures than after the surgeon had gained more experience.

 

Dr. David R. Flum, a gastrointestinal surgeon who led the study, said the real

death rate might be higher than 2 percent, because the study did not include

patients older than 65, and their risks appear higher. In addition, Dr. Flum

said, the results published in medical journals often come from the best, most

experienced surgeons.

 

" And usually, the best results have very little to do with what's going on in

the community at large, " he added. " It is particularly important that we

acknowledge that the risk of death is higher than previously reported. Nobody's

looking at new centers out there and their mortality rates. "

 

Patients who survive the surgery do live longer than very obese who do not have

the surgery, Dr. Flum's study found. After 15 years, patients who had the bypass

were more likely to be alive than those who did not, 88.2 percent versus 83.7

percent.

 

The difference was greater in patients younger than 40. Just 7.6 percent of

those patients had died, compared to 15.9 percent of those who did not have the

operation.

 

When the researchers compared survival rates starting at one year after the

operation, they found that patients who had surgery were 33 percent less likely

to die than those who did not.

 

Some obese people are extremely ill because of their weight, with heart and lung

disease, Dr. Flum said. For them, he said, a 2 percent mortality rate from

surgery may be a reasonable risk.

 

All of the several types of bariatric surgery can be performed as an open

procedure or through a laparoscope, which requires a few punctures instead of an

incision. Specialists call the gastric bypass " the gold standard. "

 

More extreme operations can bypass more of the intestine and close off less of

the stomach. Surgeons call one of the more drastic procedures the " duodenal

switch. "

 

At the University of California at San Francisco, Dr. James W. Ostroff, director

of clinical gastroenterology, said his group had been called on to revise dozens

of duodenal switches performed by other surgeons. The operation cannot be fully

reversed.

 

The revisions were needed, Dr. Ostroff said, because patients had become ill

with frequent diarrhea and cramps, flaking skin, profound anemia, liver disease

and other ailments because of poor absorption of nutrients. Dr. Ostroff said he

estimated that fewer that 15 percent of patients would have such problems but

that he still considered the operation too dangerous.

 

Dr. Ostroff said many patients had been misled into thinking that their bypasses

would solve their weight problems forever without any effort on their part. That

is not true, he said. Over time, the pouch stretches, and if people do not exert

some self-control, they will regain weight.

 

" We feel the majority of individuals will gain the weight back over about 20

years, " he said, noting that a gain of 5 pounds a year was not uncommon.

 

Ms. Culpepper, now 60, had a bypass in January 2003 at a small hospital in

Georgia. Five feet tall, she weighed 258 pounds and had diabetes and high blood

pressure. She wanted the surgery because she was convinced that her obesity

would kill her.

 

She had just one meeting each with a dietitian, a psychologist and a

cardiologist before the surgery, and there was no support group, she said.

 

After the surgery, Ms. Culpepper had respiratory failure, a heart attack, a

severe infection and other problems that kept her in the hospital on a

ventilator for several months. In that time, she lost nearly 100 pounds.

 

A lung specialist who examined her after she had been transferred to a larger

hospital said she should never have been cleared for the surgery because she had

lung disease related to her obesity.

 

When Ms. Culpepper was finally released, without the vitamins essential after

surgery, she had diarrhea much of the time and vomited so much that she could

barely eat. Her medical bills, paid by Medicare and Medicaid, ran more than $1

million.

 

She and her daughters said they believe she would have died had they not been

referred to Dr. Jensen at Vanderbilt. Fed intravenously and through a stomach

tube, Ms. Culpepper gradually regained some strength. The initial plan was to

build her up enough to withstand another operation that would in essence reverse

the bypass. Doctors suspected that she could not keep food down because her

stomach had been made too small. Ultimately, though, for reasons that her

doctors do not fully understand, she became able to eat small amounts, and the

reversal was not necessary.

 

She now weighs 127. " Right now, I'm on top of the world, " she said. " I'm happy,

I'm still fairly healthy right now. "

 

Nonetheless, Ms. Culpepper said, she wishes she had never had the operation. She

said, " I think I've been able to talk a few people out of it. "

 

Copyright 2004 The New York Times Company |

 

 

 

 

 

[Guest guest]

Hi Frank.

 

Because my sister-in-law was seriously obese, I investigated weight

loss surgery about two years ago, in the hope that if it looked at

all safe and effective, my wife and I could suggest it to her. I

quickly ruled out gastric stapling and gastric bypass. They looked to

be too dangerous---extremely uncomfortable at the very least, with a

long post-surgery recovery period.

 

But there was one procedure that looked like a possibility---gastric

banding---an operation that is done laparoscopically. It's far less

dangerous, with a much shorter recovery period:

 

http://www.drchampion.com/lapband.htm

 

It is not cheap:

 

http://www.drchampion.com/surgeryf.htm

 

I believe those who opt for gastric banding may have some difficulty

getting coverage for it from their insurance company, even though it

is significantly safer than by-pass or stapling. (So what else is

new?)

 

I joined a few chat boards where people who have been " banded "

exchange information and support each other. Some of those people

have experienced significant weight loss. Quite a few have posted

before and after photos in the files sections of the boards they're

on. They do have to be very careful they are getting proper

nutrition, and they do have to take vitamins and supplements, I

believe. They also have to regularly visit a doctor for adjustments

and some periodic procedure called a " fill. " (I asked several times

what a " fill " is, but received no response.) Those who lose

significant weight do regular exercise. There is discomfort,

especially at first, and there can be complications. The weight can

be gained back, and the band is not permanent. It needs to be

replaced at some point. (Perhaps the ideal is to get down to normal

weight, then have the band removed because one is able to maintain

proper weight without it. I am not sure of that, though.)

 

It appears to me that gastric banding can be an alternative for some

people who have become so obese that getting down to anything close

to normal weight again appears to be an impossibility. It appears

that if it goes well, and if a person can also make real lifestyle

changes, that person can head off the very serious problems they

might otherwise have encountered, such as diabetes, heart dis-ease,

cancer, etc.

 

My sister-in-law, whom I mentioned at the beginning of this post, saw

weight loss surgery as " the easy way out. " I do not think it looks

easy at all. She died in a sudden auto accident last year. Her

vehicle went out of control and rolled over, " killing her instantly " ,

the coroner said. She had recently had her 50th birthday. She was

5'6 " and well over 300 pounds, and had already been diagnosed with

diabetes. She also had a large hernia repair that had not completely

healed in over a year, due to the diabetes.

 

Great numbers of people attended her funeral. She was a much-loved

and very accomplished person, but she just could not beat the

weakness she had for ingesting more calories than she needed each day.

 

That she died instantly in an auto accident can reasonably be viewed

as merciful. It is a terribly frightening thing to contemplate---

diabetes, that is---when you learn that the dis-ease can give rise to

an infarction, or blockage, in most ANY part of one's body and make

it necessary to have that part amputated.

 

For some people, it appears gastric banding is a viable solution to

their struggle with being seriously overweight. There is no doubt,

though, that weight loss surgery is Big Business for the doctors and

hospitals that do the procedure. There is also no doubt that a

forceful, national campaign to educate people about fitness and

weight loss would be the sane, natural thing to do. That way, instead

of surgical weight loss procedures getting more refined and more

popular, they would be phased out, and would at some point be viewed

as something barbaric and strange.

 

Best wishes,

 

Elliot

 

 

, Frank

<califpacific> wrote:

>

>

> If this much is admited in a major daily newspaper you can imagine

how high the total real problems associated with this type operation

really are. Also note that now the patients need vitamins. They

almost assuredly needed them before too.

>

> If the body needs " fuel " the person has a desire to eat. If the

body needs some specific nutrients to survive and they are deficient,

the person also has a desire to eat.

>

> If the body doen't receive sufficient vitamins and minerals and

other needed nutrients, it will produce a desire to eat even if the

person is not technically hungry and if the person eats the wrong

things and doesn't get the needed nutrients, it becomes a vicious

circle and they will become obese.

>

> Also a lot of obesity is caused by damage to the brain by toxic

substances, especially some pharmacueticals.

>

> Frank

>

>

>

> http://www.nytimes.com/2004/05/04/health/nutrition/04FAT.html?

th= & pagewanted=print & position=

>

> May 4, 2004Operation for Obesity Leaves Some in MiseryBy DENISE

GRADY

>

> By the time Linda Culpepper found her way to the Vanderbilt

University Medical Center, she was in an alarming state. Her hair was

falling out, her skin was flaking, and her muscles had wasted so much

that it was hard for her to walk. She had frequent attacks of

diarrhea, and could rarely eat without vomiting.

>

> " She was a shadow of a human being, " said her daughter, Susan

Gritton.

>

> Dr. Gordon L. Jensen, director of the Vanderbilt Center for Human

Nutrition in Nashville, diagnosed her condition as life-threatening

malnutrition, admitted her to the hospital and ordered intravenous

feeding immediately.

>

> The cause of the malnutrition was complications from weight-loss

surgery performed at another hospital, specifically a gastric bypass,

a procedure that closes most of the stomach and shortens the small

intestine, often leading to weight losses of 100 pounds. That is the

operation that has strikingly transformed celebrities like Al Roker,

the television weather forecaster; Carnie Wilson, the singer; and

Roseanne Barr, the comedian.

>

> Successful cases like theirs, combined with a growing epidemic of

obesity, have led to soaring demand for the surgery. In 1995, just

20,000 weight-loss operations were performed in the United States.

Last year, there were 103,000, and this year 144,000 are projected.

>

> The surgery has become big business, and medical centers have been

scrambling to start programs.

>

> The rapid growth worries experts like Dr. Jensen, as well as some

insurers and government officials, who fear that inexperienced

surgeons and inadequate screening and follow-up may harm patients.

>

> In the last year, Dr. Jensen said, he has seen a " tremendous surge "

in patients like Ms. Culpepper who have complications from the

surgery or have not been taught how to change their eating habits to

adjust to the drastic changes in their digestive systems. Most of the

patients had surgery at smaller hospitals that were not equipped for

the problems, he said, adding that he sees as many as one such case a

week.

>

> A recent study suggests that the overall death rate is twice the

figure of 0.5 to 1 percent that is usually cited, and higher still if

a surgeon lacks experience.

>

> Researchers also express concern that the operations are being

performed on children and teenagers with scant evidence about long-

term effects. In addition, although the surgery is supposed to be

limited to people who are 100 pounds or more overweight, Dr. Jensen

and other experts said some doctors had actually encouraged obese

patients who were not heavy enough to gain more weight so they would

qualify.

>

> Dr. Philip Schauer, director of bariatric surgery, the technical

name for weight-loss surgery, at Magee-Womens Hospital of the

University of Pittsburgh, which has one of the largest programs in

the United States, said: " There are a lot of surgeons who are new to

this field and frankly haven't had much training. It's the biggest

problem we're having right now in this field. "

>

> In an interview last month, Dr. Schauer said, " I've got three

patients now that were treated by other surgeons, with major

complications. "

>

> To master a weight-loss operation, he added, a surgeon needs to

perform it 100 times.

>

> Any surgeon can perform weight-loss surgery if a hospital will

allow it. Although a professional group recommends that weight-loss

surgeons meet certain criteria, its guidelines are not binding.

>

> Citing dangers and increased costs, some insurers have decided to

stop covering the operations. In February, Blue Cross Blue Shield of

Florida called the operations extremely risky, questioned their

benefits and said it would stop paying for them after this year.

>

> Dr. Barry Schwartz, a vice president of the Florida plans,

said: " Folks now doing them and the hospitals doing them I think are

questionable. The physicians are increasingly folks with little

experience and remarkably little training, down to and including

weekend courses. "

>

> A gastric bypass usually costs $30,000, but can cost much more if

serious complications occur. The Florida insurer's spending on weight-

loss surgery nearly doubled in the last two years, to $17 million a

year, and it projected the sum to run $200 million over the next

three to four years, a spokesman said.

>

> In Massachusetts in February, the State Health Department convened

an expert panel to study the surgery because three patients died last

year during or after operations at different hospitals in Boston. The

panel is to issue a report next month and recommend ways to make the

surgery safer.

>

> The National Institutes of Health has also begun a study of the

surgery. And the professional group for doctors who perform weight-

loss surgery, the American Society for Bariatric Surgery, has begun a

program to identify " centers of excellence " for the operations,

collect information on their results and use it to help others adopt

the best surgical techniques.

>

> In the meantime, victims of botched operations or poor follow-up

care continue to turn up.

>

> Dr. Jensen said, " One of the key things we're seeing and find quite

disconcerting is that a lot of the places where the programs are

popping up don't have the evaluation and education components in

place pre- or postoperatively. "

>

> At the Tufts New England Medical Center in Boston, Dr. Scott

Shikora, an obesity surgeon, said he had seen one or two dozen

patients with complications in the past few years, referred from

other centers, usually smaller hospitals. " If you ask any major

medical center, you'll hear the same story, " Dr. Shikora said. " They

are receiving patients who were mismanaged. "

>

> Weight-loss operations are challenging even for the best surgeons,

and the enormously obese who seek them are often high-risk cases

because of diabetes or heart or lung problems. Because the surgery

makes such drastic changes in the digestive system, patients need

extensive counseling about how to eat and take vitamins, or they risk

malnutrition or weight gain.

>

> When conducted properly, Dr. Jensen said, the surgery can give

patients a new lease on life, and for many it is the only thing that

works. It can restore health, as well as appearance, quickly easing

conditions like diabetes and high blood pressure.

>

> Like any surgery, it has risks. The most common serious

complications include bleeding, blood clots, bowel obstructions,

hernias and severe infections from leaks in the belly where the

stomach and small intestines have been cut and sealed or reconnected.

>

> According to the National Institutes of Health, 10 to 20 percent of

patients need additional surgery for such complications, and nearly

30 percent develop nutritional deficiencies that lead to conditions

like anemia and bone loss.

>

> Researchers at the University of Washington looked at the records

of more than 66,000 obese people, including 3,328 who had bariatric

surgery at various hospitals from 1987 to 2001. Within 30 days of the

surgery, the death rate was 1.9 percent. Patients were 4.7 times as

likely to die during a surgeon's first 19 procedures than after the

surgeon had gained more experience.

>

> Dr. David R. Flum, a gastrointestinal surgeon who led the study,

said the real death rate might be higher than 2 percent, because the

study did not include patients older than 65, and their risks appear

higher. In addition, Dr. Flum said, the results published in medical

journals often come from the best, most experienced surgeons.

>

> " And usually, the best results have very little to do with what's

going on in the community at large, " he added. " It is particularly

important that we acknowledge that the risk of death is higher than

previously reported. Nobody's looking at new centers out there and

their mortality rates. "

>

> Patients who survive the surgery do live longer than very obese who

do not have the surgery, Dr. Flum's study found. After 15 years,

patients who had the bypass were more likely to be alive than those

who did not, 88.2 percent versus 83.7 percent.

>

> The difference was greater in patients younger than 40. Just 7.6

percent of those patients had died, compared to 15.9 percent of those

who did not have the operation.

>

> When the researchers compared survival rates starting at one year

after the operation, they found that patients who had surgery were 33

percent less likely to die than those who did not.

>

> Some obese people are extremely ill because of their weight, with

heart and lung disease, Dr. Flum said. For them, he said, a 2 percent

mortality rate from surgery may be a reasonable risk.

>

> All of the several types of bariatric surgery can be performed as

an open procedure or through a laparoscope, which requires a few

punctures instead of an incision. Specialists call the gastric

bypass " the gold standard. "

>

> More extreme operations can bypass more of the intestine and close

off less of the stomach. Surgeons call one of the more drastic

procedures the " duodenal switch. "

>

> At the University of California at San Francisco, Dr. James W.

Ostroff, director of clinical gastroenterology, said his group had

been called on to revise dozens of duodenal switches performed by

other surgeons. The operation cannot be fully reversed.

>

> The revisions were needed, Dr. Ostroff said, because patients had

become ill with frequent diarrhea and cramps, flaking skin, profound

anemia, liver disease and other ailments because of poor absorption

of nutrients. Dr. Ostroff said he estimated that fewer that 15

percent of patients would have such problems but that he still

considered the operation too dangerous.

>

> Dr. Ostroff said many patients had been misled into thinking that

their bypasses would solve their weight problems forever without any

effort on their part. That is not true, he said. Over time, the pouch

stretches, and if people do not exert some self-control, they will

regain weight.

>

> " We feel the majority of individuals will gain the weight back over

about 20 years, " he said, noting that a gain of 5 pounds a year was

not uncommon.

>

> Ms. Culpepper, now 60, had a bypass in January 2003 at a small

hospital in Georgia. Five feet tall, she weighed 258 pounds and had

diabetes and high blood pressure. She wanted the surgery because she

was convinced that her obesity would kill her.

>

> She had just one meeting each with a dietitian, a psychologist and

a cardiologist before the surgery, and there was no support group,

she said.

>

> After the surgery, Ms. Culpepper had respiratory failure, a heart

attack, a severe infection and other problems that kept her in the

hospital on a ventilator for several months. In that time, she lost

nearly 100 pounds.

>

> A lung specialist who examined her after she had been transferred

to a larger hospital said she should never have been cleared for the

surgery because she had lung disease related to her obesity.

>

> When Ms. Culpepper was finally released, without the vitamins

essential after surgery, she had diarrhea much of the time and

vomited so much that she could barely eat. Her medical bills, paid by

Medicare and Medicaid, ran more than $1 million.

>

> She and her daughters said they believe she would have died had

they not been referred to Dr. Jensen at Vanderbilt. Fed intravenously

and through a stomach tube, Ms. Culpepper gradually regained some

strength. The initial plan was to build her up enough to withstand

another operation that would in essence reverse the bypass. Doctors

suspected that she could not keep food down because her stomach had

been made too small. Ultimately, though, for reasons that her doctors

do not fully understand, she became able to eat small amounts, and

the reversal was not necessary.

>

> She now weighs 127. " Right now, I'm on top of the world, " she

said. " I'm happy, I'm still fairly healthy right now. "

>

> Nonetheless, Ms. Culpepper said, she wishes she had never had the

operation. She said, " I think I've been able to talk a few people out

of it. "

>

> Copyright 2004 The New York Times Company |

>

>

>

>

>