January 27, 2006
Weight Loss Surgery Redux
I wanted to revisit a couple of topics I addressed in earlier entries. On December 23, I discussed Starting Over, a daytime reality TV show where six women live in a house and work towards life-altering goals with two life coaches. In that entry wrote about the life coaches' schizophrenic attitude toward weight.
Well, a new housemate has joined the Starting Over family. Christie has lost 100+ after gastric bypass surgery, and her goal is to learn to love herself. In yesterday's episode, Christie's life coach, Rhonda Britton was startlingly - and refreshingly - frank about weight loss surgery. First, she pointed out that weight loss surgery has a high mortality rate. That, in itself, made me sit up and take notice. Then she had Christie perform a very interesting exercise that I think it a good lesson to plus-size women everywhere.
Rhonda took cotton batting and Ace bandages, and wrapped Christie's arms, legs, neck, and torso. The effect of the padding was that Christie looked larger than she is today, and reminded Christie of her pre-surgery body. Then, Rhonda had Christie name all of the issues she thought that gastric bypass would solve. As Christie listed the various issues - anger toward her parents, addictions, feeling unloved - Rhonda wrote them on the bandages. Rhonda's point? That Christie thought that by changing her outward appearance through weight loss surgery, all of her inner problems would be solved. It turns out, of course, that Christie has all of the same problems she had when she was much larger.
I think the lesson for all of us is that we all too often fall into the trap of thinking that all of our problems would be solved if only we were thinner. That's the message we're bombarded with from the media and the diet industry, and it's an empty promise we all too often fall for. It was refreshing to see Starting Over address that issue in a way that made sense.
The other topic I want to revisit is my mention (in my January 15 entry) of Consumer Reports coverage of weight loss surgery. I've now had the opportunity to read the article, and it's left me more incredulous than ever. Consumer Reports calls weight loss surgery a "reliable solution" to making "fat people thin." It describes two procedures, gastric bypass and adjustable gastric banding. It then reports that after two years, "the average gastric bypass patient had a BMI [body mass index] of 30." Um, a BMI of 30 means that a person is still "clinically obese."
The article also says that, "Surgery dramatically improves, or cures, [diabetes, glucose intolerance, high cholesterol, high blood pressure, degenerative arthritis]. It is not uncommon for type 2 diabetics to go off insulin for good the day after bypass surgery...." Huh? If someone weighs 300 pounds the day of surgery, there's a good chance they weigh 300 pounds the day after surgery. Why do they need insulin the day of surgery but don't need it the day after, if their weight is the same?
But I'm getting sidetracked. The article reported that, "the risk of dying during or shortly after the operation is low and getting lower - about 1 percent for bypass and 1/2 percent for banding when done by an experienced bariatric surgeon." Let's set aside the fact that many of these surgeries are performed by surgeons inexperienced in bariatric surgery, and look at the 1 percent mortality rate. This is Consumer Reports. Would Consumer Reports give a glowing review to a car manufacturer that built 500,000 automobiles, out of which only 5,000 (1 percent) blew up? Or to an appliance maker that had only 5,000 (1 percent) out of 500,000 coffee makers cause kitchen fires? Highly doubtful. So, I remain perplexed as to why Consumer Reports would advocate on behalf of an elective surgery that has a 1 percent mortality rate.
January 24, 2006
When will the FDA Protect Consumers?
CNN reported today that a U.S. Food and Drug Administration (FDA) has voted to recommend that Xenical (orlistat) be sold over the counter. The prescription drug, touted as a weight loss drug, prohibits absorption of dietary fats, and instead sends them, unabsorbed, though the digestive system. You can draw your own conclusions about the side effects.
It's no doubt that the over the counter drug, to be called Alli, will be ultimately approved by the FDA, since they usually rubber stamp the recommendations of advisory committees when it comes to diet pills (remember Redux?).
According to the CNN article, the over the counter version would be about half as potent as it's prescription counterpart. Raise your hand if you think that people, desperate for a "magic pill," will take only the recommended dosage. I don't think so, either.
With a cost of $12 to $25 a week, GlaxoSmithKline stands to rake in $1.5 billion a year in retail sales of Alli. Yes, that's billion with a "b".
Let's see.... In clinical trials over a six-month timeframe, people who took the drug lost 5.3 to 6.2 pounds more than those who took a placebo (in conjunction with diet and exercise, of course). Let's give them the benefit of the doubt and say that the over the counter pill will cost $12 a week (the lowest price point) and that the average person will lose 6.2 pounds in six months (the most optimistic outcome attributable to the drug, based on clinical trials). Six months is 26 weeks, times $12. That's $312 dollars (or $625 if you go with the highest price point). Divide the number of pounds lost into $312, and that's $50.32 per pound (or $100.80 for the high price point).
So, the FDA thinks that it's wise for consumers to pay between $50 and $100 to lose one pound, even though all admit that, once someone stops taking the drug, they gain all the weight they lost.
But, again, this is the same FDA that thought Redux - which harmed or killed untold numbers of people who wanted to lose weight - was the best thing since sliced bread, despite research to the contrary.
At what point will this governmental agency, charged with protecting the American public, actually start doing its job?
January 15, 2006
Media Running Amok
Over the past week, I've been alternately seeing red and shaking my head in disbelief over weight-related stories that have appeared in two very different kinds of publications.
Everyone in my son's fourth-grade class receives Time for Kids, a spin-off of the weekly newsmagazine for the younger crowd. For some reason, the issue he came home with on Monday was from November 2005. I subscribe to TIME Magazine and I really enjoy reading and discussing Time for Kids with my son. Each issue is accompanied by a worksheet with a number of questions pertaining to the stories in the issue. The cover story in the issue he brought home last week was
"Reading, Writing, Rock Climbing" and began by talking about a new type of P.E. class - one that emphasized individual fitness over team sports. That sounded really great to me, as I have long advocated that team sports tend to leave out big kids, and that kids of all sizes should be encouraged to engage in activities in which they can excel and that will lead to a lifelong enjoyment of movement.
But, of course, Time for Kids couldn't leave it at that. The next section of the article proceeded to sound the alarms, telling children that "obesity will likely shorten the average life span of today's younger generation by two to five years," "nearly one in three U.S. schoolchildren is overweight, and one in seven kids is obese, or seriously overweight," and "Obesity can lead to heart disease and diabetes."
This completely ticked me off. First, they oversimplified the entire issue of childhood obesity. It's true that there are more fat kids today than in previous generations, but that's due to a number of reasons. Let's start with the lack of funding in schools for P.E., the lack of funding for after school park and recreation programs, the increased incidence of latchkey kids, and the reality that it's not safe to send your kids outside to play. Then let's acknowledge that there's a genetic component to weight, and that it's to be expected that plus-size parents have plus-size kids. Finally, with all the hand wringing that goes on in school districts about childhood obesity and nutrition (at least in our school district), it's more than a little ironic that teachers routinely give kids candy as rewards.
Second, the statistics and scare tactics that Time for Kids used only served to further stigmatize big kids - who most likely are already taunted by their classmates. Let's face it - other forms of discrimination are not tolerated at schools, but size-related discrimination is almost always viewed as acceptable.
Third, Time for Kids didn't address the dangers of dieting and the ever-earlier age that kids develop eating disorders. It didn't surprise me that they didn't discuss yo-yo dieting, because they never do, but it always disappoints me. I've always advocated that both kids and adults can be healthy at any size, if health and fitness - rather than weight loss - is the goal. I can't help but wonder how many kids read that article and hated themselves just a little bit more or decided that they were going to starve themselves into thinness. Kids are exposed to enough weight-loss brainwashing as it is; they don't need to read it in material specifically written for fourth, fifth, and sixth graders.
My response? Well, the worksheet that accompanied the issue asked my son to "List three negative effects of obesity." I had a long discussion with him, and he listed: 1) discrimination in employment, education, and accommodations; 2) low self-esteem; and 3) social stigma.
No sooner had I finished fuming about Time for Kids than I learned that Consumer Reports had issued findings about weight loss surgery. Consumer Reports? Weight loss surgery? I understand that they do an excellent job of rating everything from cars to cameras to toys to washing machines. But where do they get off commenting about weight loss surgery? Although I haven't read the report, my understanding is that they come out in favor of it.
Two things immediately come to mind. First, Consumers Union is supposed to set the gold standard for impartial analysis. How can an impartial analysis lead to a finding in favor of weight loss surgery? Who exactly were the analysts? Were they obesity researchers? Were they bariatric surgeons? Inquiring minds want to know. Second, isn't it more than a little ironic that weight loss surgery is seen as a consumer issue? Have they rated appendectomies lately? Or different brain surgery techniques? There's no doubt that weight loss surgery is big - in every sense of the word - business, and that there's a lot of money behind advocating that more people have the surgery. Even though, in the long term, it doesn't work. Even though, in the long term, morbidity and mortality rates are high. What if - take the leap with me here - instead of suggesting weight loss surgery, doctors worked with large patients to improve their health status through non-surgical methods, and psychologists worked with large patients to improve their self-esteem and body image. Again, I believe that, if health and fitness - rather than weight loss - are the goals, we'd all be better off.
Just as weight loss surgery is big business, so is cosmetic surgery. Dissatisfaction with one's appearance leads women - and an increasing number of men - to turn to cosmetic surgery. A recent joint press release by the American Society for Aesthetic Plastic Surgery and the American Society of Plastic Surgeons tries to raise awareness about the dangers of unlicensed personnel performing medical cosmetic procedures in non-clinical settings. I'm sure they raise a valid point, but one can't help but wonder if there might be a financial motive as well.
With Time for Kids and other media outlets continuing to report from a place of bias, though, I'm sure that weight loss surgeons and cosmetic surgeons will have plenty of new patients in another decade or so.
January 03, 2006
Health Care for Plus Size Women
A few years ago, I was a member of the advisory board for a scientific study by researchers at the University of California, Berkeley, on the barriers to gynecological care faced by plus-size women. If you were a subscriber to BBW Magazine back then, you may have participated in a survey for the study.
The results of the study were published in the International Journal of Obesity in October 2005. The article was titled, "Barriers to Routine Gynecological Cancer Screening for White and African American Obese Women." The abstract for the study can be found at the International Journal of Obesity website.
Pat Lyons , who was instrumental in shepherding the study to completion, is a health educator who has been committed to the size acceptance movement for years. She was co-author of the book, Great Shape: The First Fitness Guide for Large Women. I received an email from her about a week ago. She summarized the study and the next steps that WomanCare Plus will take as follows:
"Based on survey data from 498 large white and African American women, we found that as weight increased, women faced increased barriers - including negative attitudes of providers, gowns and equipment that do not fit their bodies, being weighed at every visit, and receiving unsolicited weight loss advice regardless of the reason for their visit. Over 90% of the women surveyed had medical insurance, and thus were paying for care they could not routinely and easily obtain. PAP smear rates were lowest for the largest women; but regardless of weight, the women who'd dieted more than five times were most likely to delay care.
"The study also included surveys from 129 GYN health care providers, finding them sorely lacking in both clinical education and basic equipment to meet the needs of their large patients. The majority was also highly dissatisfied with referral resources for their patients.
"We discussed these results with our 16-member Project Advisory Board, composed of researchers, women's health advocates and fat activists, representatives of the California Black Women's Health Project, the California Coalition for Reproductive Freedom, physicians, and two medical anthropologists. We will be moving forward with our collaborators in the new year to address ethics, public policy, and clinical and community education programs to support every woman's right to health care delivery with dignity and respect regardless of weight. The first of these projects include:
"1) Formation of an Ethics and Public Health Policy subcommittee to sponsor a variety of educational forums to reduce health disparities caused by weight bias;
"2) In collaboration with Planned Parenthood Federation of America, development of a DVD training resource for clinical gynecological health care providers that includes an "entitlement to care" booklet for large women seeking gynecological cancer screening;
"3) Conducting 'training of trainers' focused on improving health care providers' and advocates' ability to reduce weight bias as part of their health disparities work;
"4) In a joint project with the California Black Women's Health Project, addressing the increase in gastric surgery in African American women, the risks and deaths that have gone unreported in the community and the development of alternatives to this drastic approach to weight loss;
"5) A joint project with the California Adolescent Nutrition and Fitness project to address potential delay of care in youth and adolescents, especially addressing experiences of larger youth who may be receiving aggressive dieting and weight loss advice as a result of the focus on the "childhood obesity epidemic"; and
"6) Ongoing research and education on the negative effects of dieting and weight cycling and it's relationship to delay of care."
If your experience with the health care delivery system is anything like mine, you know that receiving appropriate health care is a hit-or-miss proposition when you're a plus-size woman. I could tell you horror stories, but for now I'll share the remainder of Pat Lyons' email:
"In a Great Shape focus group we held in 1989 a woman said, " After a friend bugged me for a long time I finally went to the doctor for a PAP smear. He said I was too fat for an exam and to come back when I'd lost weight. That was 10 years ago and I haven't been back."
"I have been hearing horror stories like this - and worse - for more than 15 years in my health and fitness work across the country with large women...stories of shame and embarrassment as women have tried to access basic cancer screening and health care. Based on the publication of our two-year research study on barriers to gynecological cancer screening, I am finally in a position to mobilize community health efforts to put weight bias squarely on the table of medical ethics discussions, physician education and health advocacy training. I am asking for your tax-deductible contribution in any amount - small, large or supersize! - to launch our new project efforts in 2006.
"Your financial support will provide a community based office as a solid foundation for the WomanCare Plus Project at the CHT-Resource Group (CHT-RG) a 501(c)(3) non-profit organization in Oakland, California. CHT-RG is an affiliate of the Center for Health Training, which has for the past 26 years been a key federal family planning training contractor in several states and a major player in women's reproductive health policy, training and technical assistance. Their national reputation, networks of providers, and expertise, combined with their commitment to social justice and reducing health disparities makes them an ideal agency in which to base our efforts to ensure every large woman's cancer screening and reproductive health care rights. Ironically, beginning in 1972 I worked with the CHT founding staff and have been a consultant for them over the years. I know them well and we have already submitted two proposals to foundations to help us set up our activities. But as you know, grants take time. In the meantime, we are ready to roll!
"For those able to make a contribution, my great thanks in advance! Please make your check payable to CHT--Resource Group (put 'WomanCare Plus Project' in the 'For' line of the check). Mail it to: CHT-Resource Group, 614 Grand Ave., Suite 400, Oakland, CA 94610.
"With your help, we can make the future of health care better for all women who may be embarrassed about their weight and especially for the girls coming up behind us who have it even harder, given the current 'war on obesity.' We can share our strength and blaze the trail. I hope you'll join us!"
This project is definitely worthwhile, and I will be mailing in my contribution shortly. I will also continue to be a member of the WomanCare Plus Advisory Board.
I encourage you to support this project in whatever way you can, and to pass along this information to anyone whom you think may be interested.
Until next time,