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  1. Feministe » Seriously?
    Feministe » Seriously? January 23, 2008 at 12:23 pm |

    […] « Another example of lousy health reporting Jan 23 2008 […]

  2. Janis
    Janis January 23, 2008 at 12:38 pm |

    You know, the question I’ve always had about the surgical interventions is what happens when you reach your target weight? The answers never seemed entirely thought-out to me.

    Okay fine, you’ve lost N pounds, whatever. Let’s take that as a given. Well, eventually when you reach your goal weight, you’ll have to do the typical 1500Cal/day thing that keeps most human bodies going and maintaining their stable weight. What happens then? Do you just pound tube after tube of glucose or what?

    And let’s not even talk about the fact that high-fructose corn syrup is, in effect, industrial waste, and it’s being put into our food because we have no place else to put it.

    I can’t believe no one sees that connection — christ, I’ve found HFCS in fucking ketchup. What the hell is Karo doing in KETCHUP? We generate zillions of tons of the stuff as a by-product of industrial processes, and it ends up in everything we eat, and we’re wondering why the hell our pancreases are all turning purple and keeling over?

  3. Astraea
    Astraea January 23, 2008 at 12:54 pm |

    Damn. I had no idea what people have to go through after gastric bypass surgery. And this is called minimally invasive!?!?

    It just amazes me that people are so willing to believe that thin=healthy that they just turn off all ability to think about what these doctors are thinking.

  4. Laurie
    Laurie January 23, 2008 at 12:55 pm |

    Hell, I’ve seen HFCS in *bread*. Bread. Tell me why it needs to be *there*. :P Same with fucking sodium. Ev. Ry. Where. Bleah! (My husband ended up passing a kidney stone this fall and one of the recommendations by the nutritionist he saw was to reduce his sodium intake to 2000 mg/day. Doesn’t sound too bad until you start to LOOK at the numbers. *sigh* I’m doing a lot more totally from scratch cooking and he’s making himself crazy reading labels. Stupy food industry….)

    Not to derail the thread this early…. ;)

    Frankly, the notion of gastric surgery of any sort (for the purpose of weight loss) has always scared me. The “side effects” just seem awfully extreme. Then again, the fact that they reduce the stomach to the size of a *walnut* seems pretty extreme too.

  5. FashionablyEvil
    FashionablyEvil January 23, 2008 at 1:09 pm |

    I see two major problems here: 1. As Zuzu points out, the press is all over this a “cure” for diabetes without mentioning the complications and side effects of the surgery. 2. The follow up time was only 2 years. Granted, it’s expensive and difficult to track patients for long periods of time, but it would be good to know if the surgery increased life expectancy, given that diabetes reduces life expectancy by around 10 years.

    (Disclosure: that’s a Canadian study I’ve linked to and they don’t control for the fact that patients with diabetes often also have other conditions, such as hypertension, that may contribute to increased mortality).

  6. Janis
    Janis January 23, 2008 at 1:11 pm |

    Well, I’ve made bread, and at least there’s a real reason for having some sort of sugar syrup in it — food for the yeast to get it to rise. I’ve usually used buckwheat honey, but Karo might do the trick. Probably considerably less than the gallon and a half that’s like in your typical loaf of Wonder, though.

    Hell, the salt is probably there to balance it the hell out.

    And I’ve heard so much about groups of people, sometimes Native Americans, who were fine and dandy until they started eating a modern American diet, and suddenly their pancreases are shrivelling up like raisins and they’re keeling over from diabetes in droves. If there needs to be any MORE proof that it’s not a matter of willpower, I don’t know what it is. It’s a matter of crap being in all the food we eat and buy and of the crap-laden stuff being not only ubiquitous but cheaper. Jesus, what more demonstration do we need that we aren’t fixing the right problem?

    I’m really of two minds on this, though — I imagine there does need to be a right-now solution for someone with type 2 diabetes. But the twenty-year solution can’t just be ignored. Why the fuck is our food killing us?

  7. stonebiscuit
    stonebiscuit January 23, 2008 at 1:22 pm |

    Holy shit, no drinking with meals? One hour to drink a cup of liquid?

  8. Marie Braden
    Marie Braden January 23, 2008 at 1:24 pm |

    I chose to have GBP surgery for my own reasons, but I hate seeing the sloppy reporting that makes it seem as if surgery is an “easy fix”. It has taken me a couple of years to re-learn how I SHOULD eat, and I can honestly say that the simple fact of where the people involved in this study are receiving their funding SHOULD make a reader pause. Unfortunately, in too many cases, the reader just takes away whatever the headline told them without looking deeper into who would benefit from the article. The complications of bariatric surgery are legion–I would never recommend it to anyone, even though it was the right choice for me.

  9. Shinobi
    Shinobi January 23, 2008 at 1:48 pm |

    Gastric bypass is essentially a medically enforced eating disorder. I can’t believe they recommend this as a “cure” for anything. UGH

    Obesity Hysteria is the real epidemic this country is facing.

  10. Ozzie
    Ozzie January 23, 2008 at 2:22 pm |

    Like an earlier poster said, you need sugar to feed the yeast so that bread can rise in the first place, otherwise, you’re just makin’ crackers. A small amount of salt is not bad for you- if you make something without salt that ‘needs’ it, it will taste soapy and weird. By all means there is excessive sugar/salt/anything in most commercial food. I’d further argue that despite what it’s called and where it’s sold, Wonderbread, Chef Boyardee, 80% of prepared commercial food isn’t food at all. Eating real food will not kill us.

    And yes, real food costs a lot more money than WonderCrap, which makes it really hard for the very people who are genetically predisposed to diabetes (referring to non-white people, who according to Wikipedia all seem more likely to have diabetes and according to my understanding seem more likely to be stuck in low-income situations or kept from getting out), when they’re surrounded by things that cause diabetes.

    I’d love to see 1/10 of the money that goes into this nonsense get shifted towards agricultural subsidies for real, healthy food and produce stands in low-income areas. While I’m at it, I also want a pony.

  11. Jennifer
    Jennifer January 23, 2008 at 2:33 pm |

    Since when is diabetes curable? Seriously? The hell?

  12. Rose
    Rose January 23, 2008 at 2:40 pm |

    I’m baffled by this study. When my husband eats too little food his blood sugar goes up! Self-starvation is no healthier for diabetics than overeating sugary foods is.

    Something tells me this “research” is a serious crock!

  13. Janis
    Janis January 23, 2008 at 2:49 pm |

    Good food isn’t always expensive, but the problem is that it takes more support than people realize to have it. First, you have to live close enough to a good supermarket or a farmer’s market. Lots of people don’t, especially in poorer areas. And then there’s the classic “how do you cook and store healthy food if you don’t have a freezer?” question.

    If there’s noplace near you to get good food without massive inconvenience or expense, and you can’t cook and freeze … it doesn’t matter if the bell peppers only cost $0.25 apiece.

  14. Heather
    Heather January 23, 2008 at 3:01 pm |

    I worked at a nursing home where we gave many of our patients liquid and/or pureed food diets. No normal, sane person would want to eat that stuff. It was usually only our very ill residents that went on the most extreme diets (fully pureed food). Do you know what any and every type of meat and veggie looks like pureed? I do. I’d rather be ‘fat’ and ‘physically unattractive’ before I spent any amount of time eating that food. And to think people do it by choice.

  15. Shirley
    Shirley January 23, 2008 at 4:00 pm |

    These stories piss me off to no end. My mother, who has been thin her entire life, was just diagnosed with Type II Diabetes. Because of all thes OMG THE FAT THE FAT THE FAT CAUSES DIABETES stories, she JUST CANT UNDERSTAND how she could possibly have Diabetes. Meanwhile…she’s doing very little to help herself – why? well, she’s already thin! that’s all you need to be healthy, right? ***sigh***

  16. Mnemosyne
    Mnemosyne January 23, 2008 at 4:27 pm |

    Since when is diabetes curable? Seriously? The hell?

    It’s not curable, but Type II is usually controllable with diet and exercise. And not diet as in “lose weight” diet, but dietary changes to control your intake of carbohydrates and sugars.

    In fact, as zuzu points out, I think what this study really shows is how closely Type II diabetes is related to diet (what you’re eating) and not your weight per se. Which makes all those stories of impoverished kids developing Type II diabetes not so bizarre anymore.

    On bariatric surgery, I can see it being necessary for people who are so obese they can’t function — I mean people who are literally bedridden. That very small group of people are the ones for whom obesity itself is dangerous to their health and losing the weight rapidly will bring some benefits.

    Everyone else? Not so much.

  17. wriggles
    wriggles January 23, 2008 at 4:39 pm |

    I’ve heard of this effect only in terms of Gastric Bypass and a scientist was speculating that it could have something to do with certain nerves to the stomach getting cut in the process.

    If they gave a damn about the body’s of fat people/diabetics, they might have investigated this kind of thing first, but hey if you’re a fatty you don’t need a functioning stomach do you?

  18. Kevin T. Keith
    Kevin T. Keith January 23, 2008 at 4:49 pm |

    The question of side effects from these surgeries is a very important one. And the generally distorted state of both the food and healthcare systems, creating conditions for disease and then providing drastic solutions to them, is also a travesty. And finally the social phobia over large body size is also a source of pressure for unhealthy and destructive practices.

    But the commentary on these articles seems rather ill-considered. The issue in question is weight loss aimed at treating Type 2 diabetes and other health risks. It may be true that certain factors tend to push people into those conditions, and it would be preferable to find healthier ways to avoid them, rather than impose further risks from treatment after the fact. But that’s not the question on the table. There are many people suffering from such conditions right now – people for whom “reforming health care” is not a realistic treatment strategy. What should they do? Presumably, the right way to answer that question is the same way we would answer questions about any medical treatment: consider the options, and compare their risks and benefits.

    We know that the vast majority of people who attempt to lose weight by diet and exercise have, literally, no success at all. And we know that many of them face severe health threats. Diabetes is a very serious condition and it has very serious consequences, including death. Non-treatment (which is essentially what “dieting” equates to) leads to a progressive course of increasingly severe harm to the liver, circulatory system, and other parts of the body. Treatment by medicine is relatively safe and can reduce much of the harm, but is essentially a lifetime sentence to drug treatments that have their own side effects, but no weight loss and no real cure. Treatment by surgery carries a certain risk of harm or death from the surgery itself, a somewhat uncomfortable recover period of several months, and radically changed eating patterns for the rest of one’s life, with almost a guarantee of considerable weight loss and health improvement. Broadly speaking, those are the options. Which is best? That depends on circumstances. The standard procedure is to compare the likely risks and benefits for each patient, and choose the option that offers the best balance. (There is room for personal preferences: patients willing to accept some risk, or in greatest need of help, may opt for the best likely outcome even with higher risks, while those more risk-averse or less desperate may choose the safest treatment even with lesser likely benefits. These are reasonable tradeoffs.)

    But in the discussion above, there seems to be uniform hostility to one proposed treatment, apparently grounded on frustration with the need for treatment at all, or in suspicion about those offering the treatment. There seems to be little attempt to consider the relative risks of treatments – only the fact that there are risks seems to matter. But of course there are risks. And there are alternative courses of action. And you can compare the two.

    Sure, you may die, you may vomit, your stomach might be perforated, and your hair might fall out, but you’ll have lost the weight and that’s all that’s important!” Well, it may also be important to get rid of the diabetes that is killing your liver and collapsing your circulation, leading to nerve damage, embolisms, gangrene, progressive amputations, and blindness . . . or death. Is it conceivable that the less than 1/2 of 1% risk of death from surgery would be worth taking to avoid a lifetime of progressive deterioration of that kind? It seems more than conceivable to me, for some people.

    The discussion here does not seem to be just a complaint that the articles downplay the risks of surgery – it seems to me to be a replication of the same msitake from the opposite perspective: a mere recitation of nothing but the risks of surgery, as if there were no reason at all why those risks might be reasonable in some cases. That’s hardly better, nor even much of a corrective.

    The comments seem similarly blindered. Some demonstrate, or even openly confess, ignorance and then blithely jump to hostile conclusions:

    Well, eventually when you reach your goal weight, you’ll have to do the typical 1500Cal/day thing that keeps most human bodies going and maintaining their stable weight. What happens then?

    You eat multiple small meals a day. Now you know.

    And let’s not even talk about the fact that high-fructose corn syrup is, in effect, industrial waste, and it’s being put into our food because we have no place else to put it.

    It’s put into food because it’s digestible and tastes sweet, and so is a cheap substitute for sugar.

    I can’t believe no one sees that connection — christ, I’ve found HFCS in fucking ketchup. What the hell is Karo doing in KETCHUP?

    Catsup traditionally includes a sweetener – it balances the acid from the tomatoes. Go look (and learn . . . and stop shouting). Every recipe for catsup includes sugar. Corn syrup is used in commercial catsup for the reason given above. Why this matters, I don’t know, but you could have found out the answer without assuming it was some kind of conspiracy.

    I’m baffled by this study. When my husband eats too little food his blood sugar goes up! Self-starvation is no healthier for diabetics than overeating sugary foods is. Something tells me this “research” is a serious crock!

    When your blood sugar drops, your liver releases enzymes to mobilize stored sugar reserves, temporarily spiking blood sugar back up (though it drops again when those reserves are depleted). Eating too much sugar also sends blood sugar up by directly pushing sugar into the blood from the digestive tract. The trick is to maintain an even and moderate level of blood sugar by monitoring food intake, especially when the liver’s ability to balance the blood sugar has been compromised by diabetes. Gastric surgery does not aim at producing a pathologically low blood sugar level; it aims at reducing total calorie intake. You can still balance your blood sugar by balancing what you do eat, during both the recovery and weight-loss period and the weight-maintenance period.

    The fact that your husband’s blood sugar cycles with food intake is evidence that he has diabetes; it is not evidence that a scientific study on a different issue, involving multiple experiments on in some cases hundreds of patients, is a “crock”. Being baffled is not evidence.

    Since when is diabetes curable? Seriously? The hell?

    As the quotes from the articles actually included in the post clearly state, Type 2 diabetes is an acquired condition that results from excess body weight. Its symptoms can go away completely if the weight is lost. (Basically, your liver can only handle so big a load. If it has to control blood sugar for an extra 50 or 100 pounds of body mass, it not only can’t handle the job, it begins to be damaged by the excess sugar in the blood. If you get the weight off, you can get back to a state where your existing liver function is adequate to control your blood sugar without medication.) Type 1 diabetes (childhood-onset diabeties) is an inherited condition that can’t be cured, but can be controlled. They’re different. The article explains that.

    In other cases, people are clearly just expressing personal values or perspectives, without even an attempt to consider alternative choices or other points of view:

    Gastric bypass is essentially a medically enforced eating disorder. I can’t believe they recommend this as a “cure” for anything. UGH

    It’s a surgically enforced reduction in intake capacity. It gives you a smaller stomach. How you eat is up to you.

    They recommend it as a cure because it completely eliminates the symptoms of the major disease (diabetes) it is intended to cure, and greatly reduces the symptoms of others (sleep apnea, hypertension).

    Obesity Hysteria is the real epidemic this country is facing.

    As the articles made abundantly clear, these surgeries are aimed at weight-related health conditions that are responsible for not-inconsiderable numbers of deaths each year. What is “hysterical” about not wanting to die from diabetes, sleep apnea, heart attack, or stroke?

    I’d rather be ‘fat’ and ‘physically unattractive’ before I spent any amount of time eating [pureed] food.

    Would you rather have diabetes for a lifetime than eat pureed food for two or three months? And does everyone else have to give the same answer as you? Those are the choices in question.

    It just amazes me that people are so willing to believe that thin=healthy that they just turn off all ability to think about what these doctors are thinking.

    Even granting that more discussion of tradeoffs and risks was needed, the articles quoted made it very clear that the people choosing these treatments are not merely suffering the immediate problems of high weight (back pain, tiredness, shortness of breath, foot pain, etc.), but in many cases very real, severe, and life-threatening diseases directly related to weight, including diabetes and others. They are not thin and they are not healthy – and in these cases at least, losing weight is what is required to make them healthy – and it is reliably known that losing weight will actually do so for almost all of this specific, carefully-defined, and quite numerous, subset of patients. It seems fairly obvious what they are thinking (they are tired of being sick, and they don’t want to die prematurely), and there’s no reason to imagine they have been conned into thinking those things.

    Assuming other people are stupid for making health choices you don’t approve of – in the face of serious health threats that you don’t seem to want to believe in (or, in many cases above, patently don’t know about or understand) – hardly seems like a respectful, or helpful, way to advocate for health policy. Of course risks are important, and should be discussed in context – though I hope nobody is going to rely on a wire-service article as their primary source of information on this topic. And of course improvements in both the food supply and healthcare industries are important, entirely aside from this issue. And of course a 20-year solution aimed at reducing the incidence of health-threatening eating and lifestyle practices would do more good than drastic after-the-fact treatments. But we have to deal with the problem we have right now. And doing so is a matter of pursuing multiple alternatives and letting people make informed choices among them. Dismissing one entirely because you’re offended that it is not perfect, or you simply don’t like the way it came about, does no one any good.

  19. Thlayli
    Thlayli January 23, 2008 at 5:32 pm |

    Hell, I’ve seen HFCS in *bread*. Bread. Tell me why it needs to be *there*. :P

    It’s a preservative — in its normal form, bread is not known for its shelf life.

    Pretty much everything in the “bread” aisle will have some kind of artificial assistance. The fresh stuff is off in the corner, by the birthday cakes. I suggest sticking with that.

  20. Janis
    Janis January 23, 2008 at 5:52 pm |

    You mean food isn’t supposed to last for ten months in the pantry?! Next, you’ll be telling me President Bush lied!

  21. roses
    roses January 23, 2008 at 9:11 pm |

    Kevin, did you read Zuzu’s critique, or did you just skip straight to the comments? Her main problem with the study was that improvement in the diabetes happened within days of the surgery – before a substantsive amount of weight was lost. Which means it’s not the weight loss causing the improvement, it’s something else. Probably the change in diet enforced by the surgery – in which case diabetics can achieve the same effect without going through risky surgery – they just have to modify their diets.

    Further, obesity has not been proven to cause diabetes, it’s just strongly correlated with it. It could be that (as some scientists theorize) it’s actually the diabetes that causes the obesity. Or it could be that there is an underlying factor that causes both.

  22. Mnemosyne
    Mnemosyne January 23, 2008 at 9:28 pm |

    We know that the vast majority of people who attempt to lose weight by diet and exercise have, literally, no success at all.

    Here’s the interesting thing: bariatric surgery isn’t a miracle cure, either. Whether you lose weight by diet and exercise or lose it due to surgery, you WILL gain it back if you go back to your old habits. All surgery does is physically enforce an extremely restricted diet rather than have you follow it voluntarily.

    And Jesus Christ am I sick of the meme that no one anywhere has ever successfully lost weight and kept it off. Some of us have, but only by monitoring what we eat at every single meal and keeping track of our intake, which is not something that most people are willing to do or are willing to stick with.

  23. Tonya
    Tonya January 23, 2008 at 9:32 pm |

    Kevin T. Keith says:
    As the quotes from the articles actually included in the post clearly state, Type 2 diabetes is an acquired condition that results from excess body weight. Its symptoms can go away completely if the weight is lost.

    Actually, Type 2 diabetes is not a result of excess body weight – THAT is what the study clearly tells us. Type 2 diabetes is a result of poor eating habits, combined with some genetic predisposition. I think the concern over the risks of surgery being downplayed are extremely important, because diet and exercise (when people actually bother to follow it) has the exact same effect as the surgery. Yes, I think people should have the choice to make better diet choices without surgery or have the surgery (which essentially just enforces good diet choices through pain and suffering when you eat poorly), but the risks of the surgery need to be clearly laid out.

    From the article above:
    The amount you can eat gradually increases, but you won’t be able to return to your old eating habits.

    Eventually, you can return to your old eating habits. There are plenty of people who have regained most or all of the weight following surgery, with the accompanied disease symptoms. The surgery is not a permanent cure.

  24. roses
    roses January 23, 2008 at 10:32 pm |

    Some of us have, but only by monitoring what we eat at every single meal and keeping track of our intake, which is not something that most people are willing to do or are willing to stick with.

    A lot of people aren’t able to stick with it. The amount of calorie restriction required to lose significant amounts of weight and keep it off is just not sustainable for a lot of people. Eventually their bodies demand food.

  25. Craig R.
    Craig R. January 23, 2008 at 10:33 pm |

    Excuse me?

    A study of *60 people* was supposed to be definitive?

    Does the phrase “statistically significant sample population” appear in the research lexicon in Australia? Or as it excised by the grant-approval office of Allergan?

  26. Oh
    Oh January 24, 2008 at 2:47 am |

    We know that the vast majority of people who attempt to lose weight by diet and exercise have, literally, no success at all.

    Yeah, that’s because a lot of societies today have set up opportunities for eating and physical activity in an extremely unhealthy way. Choosing a diet and exercise regimen to promote weight loss tends to involves setting up a lifestyle that feels unnatural, that requires bucking social norms. The vast majority of people have a hard time continuing to choose to buck social norms–it’s the basic mechanism that allows humans to form stable societies.

    When I live in the US, I tend to be a bit overweight. Never unhealthy, but overweight to a varying degree. When I go to other countries for a few months and live the way the people there do, I very quickly lose all excess weight with no effort whatsoever. When I come back to the US and live the way people here do, I put weight back on.

    The fact that I wouldn’t be likely to meet with success on a weight-loss diet and exercise plan in no way means surgery would be appropriate. I do think it would be appropriate for the obesity-hysterics to start looking more at societal conditions than individual choices.

  27. kali
    kali January 24, 2008 at 3:07 am |

    My introduction to the concept of gastric banding surgery was reading an article about how wonderful it is, based on an interview with a middle-aged socialite who had tried absolutely everything to lose the two stone (thirty pounds) she needed to get down to the weight she had been in her modelling days. Ever since the surgery she had lived happily ever after! The article didn’t even mention any risks.

    Daily Mail, naturally. I know this comment is only tangentially related, but I just had to share the pain.

  28. Vox
    Vox January 24, 2008 at 5:56 am |

    FWIW, the AP studied said that diabetes went into remission within two days after gastric bypass surgery, and within two years after lap-band. However, if I recall, they don’t actually explain that this is Type II diabetes only, which has got to suck for the person who has juvenile diabetes when they research and find out the truth.

    That said, I think the media has jumped the gun on this, and even if it does turn out to be something to do with surgery, I would hope that it would be a last-resort measure due to side effects and complications (i.e., they let you do it only if your kidneys are about to fail or something).

  29. wriggles
    wriggles January 24, 2008 at 11:10 am |

    But the commentary on these articles seems rather ill-considered

    Including yours especially, yet again with the belief that fat people are cretins who obviously cannot understand that diabetes is a serious condition, which is odd as you claim that fatness causes it. If so, fatties have all got it and would know all about it.

    What is ist about you people that cannot understand that it is possible to honestly disagreee with you? You think that you are so right that anyone disagreeing with you must be in remedial class, I especially enjoy you implying that we (mostly) silly women couldn’t possibly grasp the complexities (and the innate machismo) of science, because we cannot kept our emotions out of things. We just couldn’t have thought things through, clinically otherwise we would obviously agree with you. Try to get this once and for all, we disagree with you based on our reading of things, OK?

    And Jesus Christ am I sick of the meme that no one anywhere has ever successfully lost weight and kept it off

    We know that the vast majority of people who attempt to lose weight by diet and exercise have, literally, no success at all.

    Some of us have, but only by monitoring what we eat at every single meal and keeping track of our intake, which is not something that most people are willing to do or are willing to stick with.

    Mnemosyne, I hope you haven’t run away with the idea that what is stopping everyone from successful long-term weight loss is mere disinclination to track their eating. Because that would be like being told that you need to ‘tough out’ depression. Monitoring eating is no more the answer than any other forms of calorie restriction with exceptions such as yourself, because most people’s nervous system puts up a bigger, better and stronger fight, similar to the fight your depression puts up to your ‘willpower’.

  30. Mnemosyne
    Mnemosyne January 24, 2008 at 12:00 pm |

    roses: A lot of people aren’t able to stick with it. The amount of calorie restriction required to lose significant amounts of weight and keep it off is just not sustainable for a lot of people. Eventually their bodies demand food.

    A lot of people don’t realize that an average-height 200-pound woman who restricts her calories to 1200 a day is shutting down her metabolism and is absolutely setting herself up for failure. A lot of people — doctors included — don’t realize how common it is for overweight people to already be restricting their diets in an unrealistic way, so telling them “cut calories and exercise” will only lead to frustration, because going from 1200 calories to 800 calories will make you nuts.

    This is why, as I’ve said over and over again, people who have a significant amount of weight to lose should consult with a registered dietician to find out what the appropriate caloric intake is for their current weight. If you try to do it on your own without getting that information, you are setting yourself up for failure, because you will not be eating enough.

    wriggles: Mnemosyne, I hope you haven’t run away with the idea that what is stopping everyone from successful long-term weight loss is mere disinclination to track their eating. Because that would be like being told that you need to ‘tough out’ depression.

    It’s interesting that you compare overweight to depression, given that there’s a study showing that they are closely linked. I know that when I was depressed, I was overweight, because it was impossible for me to follow a diet or exercise plan without beating myself up constantly for my “failure” if I God forbid ate a cookie, which sent me right back into the spiral of self-hatred and self-recrimination. Until I treated the underlying cause, I wasn’t able to change my habits.

    As I’ve said many times before on these threads, I think that being overweight or obese is usually a symptom, not a cause. If you can’t exercise because of arthritis pain, you’ll probably gain weight, but that doesn’t mean that your main problem is that you’re overweight and the solution is to lose weight. That means the problem is that your pain is poorly controlled, and you need to demand better pain relief. If you gain weight no matter how little you eat, get your doctor to check you for PCOS and thyroid problems.

    Human beings come in a range of sizes, and there are always going to be people at both ends of the scale. But I think both ends of that scale have fewer people than you’d like to think, which is why so many actresses and models have eating disorders — they’re unnaturally keeping themselves at the low end of the scale when they should be somewhere in the middle like the rest of us.

  31. TinaH
    TinaH January 24, 2008 at 1:37 pm |

    people who have a significant amount of weight to lose should consult with a registered dietician to find out what the appropriate caloric intake is for their current weight. If you try to do it on your own without getting that information, you are setting yourself up for failure, because you will not be eating enough.

    Emphasis Tina’s. This, for me, is completely counter-intuitive but completely true. I am not eating enough food to lose weight.

  32. Mandolin
    Mandolin January 24, 2008 at 1:49 pm |

    ‘k. Mnemnosyne, what has worked for you is great, but may not work for everyone else.

  33. Xanthippas
    Xanthippas January 24, 2008 at 1:52 pm |

    I’m not sure what’s so “sloppy” about the reporting here. The author isn’t writing about gastric bypass; she’s writing about the use of gastric bypass (and lap band surgery) to reduce or eliminate the symptoms of diabetes in obese patients. Gastric bypass has been around awhile, and I’d be a little surprised if a majority of people don’t know how difficult, life-altering and dangerous it can be. But I do know that the ultimate side effects of diabetes-amputation, blindness, etc.-are terrible, and even the extraordinarily invasive gastric bypass procedure may be preferable for patients who are simply incapable of losing the weight through lifestyle changes.

    I’m not sure what drives the hostility to this article. Clearly, we are discussing a set of people who are seriously obese and face crucial health problems without lifestyle changes. This article is hardly a recommendation in favor of gastric bypass surgery in general.

  34. wriggles
    wriggles January 24, 2008 at 1:53 pm |

    So the reason why the weight of the world is on a bit of an upswing is the glands, no it’s PCOS, no it’s that they didn’t know better than to starve – shutting down their metabolism? (Is that death?)
    It is obvious that something is triggering this, and we need to find out what that is and viable ways of correcting it. If it doesn’t work, it shows it doesn’t work….. by not working.
    If depression is linked then this has ramifications for that as well as diabetes and anything linked to weight, high or low. The problem with dieting whether it’s ‘crash’ or ‘sensible’, no matter what , the body is programmed to make good it’s loss, it’s not even unique to calorie control, it happens when you manipulate the thyroid, when you ‘speed up’ the metabolism with amphetamine and when you cut away healthy stomachs. The failure is the same, there is no secret there is no key, it is fundamentally flawed.
    The diet/ weight hypothesis is not a religion, it’s dead, RIP (rest in piss).

  35. Mandolin
    Mandolin January 24, 2008 at 1:56 pm |

    Also, PCOS affects a truly large number of women. It might be safer to assume that the overweight person you’re talking to has already tried your methods (oh, jesus, have we), and found they haven’t worked for us — perhaps due to things like PCOS — than to assume that we haven’t tried everything from anorexia to weight watchers to nutritionists.

    I agree with whoever said the GBP and lap-band surgery are just medically enforced eating disorders. I don’t get that. I can give myself an eating disorder on my own, thanks — particularly if I can get medical sanction for it. Half of the stress of having an eating disorder is having to hide it.

  36. Mandolin
    Mandolin January 24, 2008 at 1:58 pm |

    “Clearly, we are discussing a set of people who are seriously obese and face crucial health problems without lifestyle changes. ”

    Would you like some tea to go with your othering?

  37. Mnemosyne
    Mnemosyne January 24, 2008 at 2:07 pm |

    ‘k. Mnemnosyne, what has worked for you is great, but may not work for everyone else.

    Yes, which is why I said that in my first reply.

    Let me put it another way.

    I do not run marathons. I have no interest in it, and I don’t want to put in the huge amount of training, stress, and money it would take to turn me into a marathon runner.

    Am I bad and lazy because I don’t run marathons? Or is it just something that would be difficult for me to do with very little reward, so I choose not to do it?

    The thing that drives me crazy about the meme that being overweight is just how it is for most people is because of what Oh says — American society is pretty much set up to make people gain weight. We’re herded from cars to offices to malls to the couch like veal. Kids are lucky if they get recess in school, much less actual PE classes. Joining a gym takes money, but a lot of people live in suburbs where they didn’t bother to build sidewalks, so their only option is to walk in the road and possibly get his by a car or drive 10 miles to the gym. Every country that has adopted the American lifestyle has found that their rate of overweight and obesity has soared. That seems a pretty clear indicator that the problem is our society, not individuals.

    To pay attention to every message you get on TV, research every menu item in every fast-food restaurant that you go to, and read the label of everything you buy at the grocery store is a gigantic pain in the ass, and I’m not surprised at all that most people choose not to do it. Again, it doesn’t mean that they’re bad and lazy and don’t care about themselves. It means that it’s a gigantic pain in the ass to fight against the system that’s set up in this country. Frankly, I don’t blame people for not doing it. I kind of like it — it’s a game to see what they’re trying to slip into my diet under the guise of “healthy” — but it’s not for everyone.

    However, to extrapolate from “it’s hard to fight the system” to “no one can lose weight” makes no sense.

  38. Sepra
    Sepra January 24, 2008 at 2:43 pm |

    A lot of people aren’t able to stick with it. The amount of calorie restriction required to lose significant amounts of weight and keep it off is just not sustainable for a lot of people. Eventually their bodies demand food.

    You can restrict calories but not food. It’s pretty easy, actually. Eat large (and I mean large) amounts of low-calorie, natural food (vegetables, fruits) and very small amounts of higher calorie, less nutritious food (processed breads, meats, high fat dairy). I can fill myself up on 1200 calories with that, or I can be starving on 1600 calories of processed stuff. Lost 20 pounds and dropped 30 points in cholesterol that way and kept it off too, but you do have to be somewhat vigilant. But not hungry.

    American society is pretty much set up to make people gain weight. We’re herded from cars to offices to malls to the couch like veal… Joining a gym takes money, but a lot of people live in suburbs where they didn’t bother to build sidewalks, so their only option is to walk in the road and possibly get his by a car or drive 10 miles to the gym. Every country that has adopted the American lifestyle has found that their rate of overweight and obesity has soared. That seems a pretty clear indicator that the problem is our society, not individuals.

    I agree wholeheartedly. Obesity is a problem in this country. But it’s not that anyone is lazy or lacks willpower, it’s that it is simply very difficult to maintain a healthy weight in the US. I hate going to the gym, and when I lived abroad, I didn’t have to: with the public transportation and whatnot, I was walking more often than I ever have here. I also think HFCS has something to do with it.

    So, it’s not a moral failing if someone is overweight, but it is something I think we as a society need to look into. Like, why are Americans fatter than we were 30 years ago? There has to be a reason, but people are too busy attacking or playing defense to find an answer. My personal belief is that nutrition is the answer, but how is something to ask.

  39. annalouise
    annalouise January 24, 2008 at 3:00 pm |

    The hostility and skepticism to this story is based on an awareness of how fatphobia influences any scientific study on fat-related issues and how it pretty much destroys any mass media reporting on said stories.
    I think a good parrellel would be hormone replacement therapy. It was easy for science and the media to overstate the benefits of HRT and underplay the serious risks because of the overarching belief that the aging process in women is disgusting and that it’s worth the risks for post-menopausel women to be bright eyed and sexually responsive. Just like how the overarching belief that fat people are disgusting and that any risk is worth it to make us thin and desirable.

  40. Sepra
    Sepra January 24, 2008 at 3:22 pm |

    Sorry zuzu, I just wanted to say that I think society has failed people when it comes to food and obesity. It wasn’t supposed to be part of a larger “People Are Fat OMG!” discussion.

    I think you’re right on that it’s not the weight loss, it’s the diet that changes diabetes. Unfortunatley, with the lack of education about nutrition, it’s difficult to change on our own. And articles like this do not help.

  41. Mandolin
    Mandolin January 24, 2008 at 3:58 pm |

    “Do we really have to have this argument again?”

    Apparently, yes.

    Mnemnosyne has decided to opine that if everyone were to follow her formula, we would have her results. Her body is not my body; she doesn’t know what the fuck goes on with my flesh. It’s no different than opining that no one should use antidepressants cuz they don’t work for one person, or conversely that everyone should cuz they happen to work for me. I’m fortunate that they work for me; I don’t therefore conclude that they would work for Mnemnosyne.

    I get that you don’t like the frame, and neither do I. But I’m not the one who brought up the subject, and I’m not inclined to let Mnemnosyne’s misinformation pass.

  42. Mandolin
    Mandolin January 24, 2008 at 4:02 pm |

    My other point was that something like 10% of the population has PCOS, and I imagine that if you start looking at women with lifelong, durable weight problems that percentage would go up even higher. Mnemnosyne is talking about us like we’re an exception, when I think it’s more likely we’re the rule.

    I’ve said my piece here, now, and won’t address this topic again.

  43. Xanthippas
    Xanthippas January 25, 2008 at 11:00 am |

    As for the weight-loss discussion that is beginning: hey, don’t you guys remember my post about Rejecting the Frames? Do we really have to have this argument again?

    And your post seems to be driven by concern over the larger weight-loss issue. That’s not what this article is talking about. It’s talking about the use of a fairly radical procedure for people who are so seriously obese and afflicted with diabetes that they face very real risks of debilitating consequences of the disease. It’s not that I don’t agree with you about the larger issue. It’s that discussion of that is not necessarily applicable to this particular article.

    As for your example, I contend that most people are fairly familiar with what gastric bypass is and what it entails. Whereas hardly anybody would know about that sort of treatment for alcoholism. But I could be wrong.

    Anyway, diabetes is rampant in my family and I’ve seen the very real consequences of the failure you to treat it vigorously and comprehensively. So, that’s where I’m coming from, in case you’re wondering.

  44. wriggles
    wriggles January 25, 2008 at 12:56 pm |

    It’s talking about the use of a fairly radical procedure for people who are so seriously obese and afflicted with diabetes that they face very real risks of debilitating consequences of the disease.

    If you are so seriously obese, they will not operate on you. This ‘procedure’ itself is debilitating, in the short and long-term, which is omitted from the article which is the crux of this post. Your assumption that people are familiar with the in’s and out’s of GBP is nonsense as this kind of omission and the trivialisation of its effects are par for the course in the media. Most people don’t even realise that healthy organs are butchered to function at a far lower level than before, something that ethically unsound.

    The fact that they are trying to pass this off as an innovation for diabetics-Type II of course, the ‘undeserving, self-inflicted’ kind, do you think they would dream of offering this kind of thing, to say Type I’s?, or anyone else? If they did, I bet they would spit at it, only the ‘obese’ convinced by those that are supposed to put their well-being first that their is no amount of pain and discomfort that is not acceptable, because it is somehow ‘deserved’.

    diabetes is rampant in my family and I’ve seen the very real consequences of the failure you to treat it vigorously and comprehensively

    I am truly sorry about that Xanthippas, but I believe that your family members deserved the best that can be achieved for them, and they, in my view are not likely to get that whilst the ‘obesity crisis’ takes prescidence over medical ethics.

  45. diabetesgirl
    diabetesgirl January 25, 2008 at 11:48 pm |

    There’s some information missing here and some confusion. There is a reason that gastric bypass can “cure” diabetes. The procedure apparently removes a portion of the intestine that absorbs carbs. If you aren’t actually absorbing carbs, then you’re blood sugar can’t go up.

    Weight loss can make Type 2 better for some people but really your genes have a lot to do with it as many thin people do get type 2. Type 2 isn’t just a disease of obese people.

    I lost nearly 100 pounds (diet and exercise) and have made my diabetes much better. Some doctors might even say “cured” but I know very well if I went on a high carb diet, I would quickly show up very diabetic again. It’s a good thing my doctor agrees with me.

    The other disservice this study does it really does not publish the dangers of surgery. Recent studies showed that people who had undergone gastric bypass were more likely to commit suicide, they were also more likely to die than obese people of the same age. Complications from these surgeries can be very severe and many regain the weight.

  46. River
    River January 26, 2008 at 12:34 am |

    In all this talk of WLS and diabetes, nobody seems to mention that the diabetics themselves should be asked what they want!

    Yes, diabetes complications are nasty. It takes a while, sometimes quite a while, to get blood glucose under control with oral diabetes medications. The method that is being pushed now is to stick Type 2 diabetics on insulin early. There is a lot of paternalism when it comes to treating diabetics, and I’m seeing more of that in this article and in some of the comments here.

    It is ridiculously hard to lose weight on some diabetes treatment regimens. Heck, two of the main oral drugs used to treat diabetes, Avandia and Actos, actually cause weight gain. I got put on Avandia about three years ago, noticed significant weight gain (over 10 pounds) within two weeks with absolutely no increase in eating, and insisted that I get taken right back off.

    I do note a lot of “you should want this, you should want that” here in discussing the treatment options for diabetics. Do you enjoy your food? Want to continue to enjoy it, without overdoing but *with* being able to eat in a normal manner? It’s bad enough being on a restricted diet and having people ask you all the time “are you allowed to eat that?” Add to that the new enforced eating style that comes with weight loss surgery, and people will really stare and turn into the food police. Maybe some of these diabetics to whom this treatment is being pushed want to continue to have normal, social meals. Their preference doesn’t seem to be taken into consideration.

    I got diagnosed 12 1/2 years ago. I was fat, but never obese. My mother went so far as to call me up to tell me about this article, and regret that the research hadn’t been done when I was first diagnosed. I pointed out to her that this is major surgery and extremely risky, but that didn’t seem to matter; it would have made me thin, and therefore acceptable in her eyes.

    I have extremely well controlled diabetes. I see my nutritionist monthly. It wasn’t always the case, and I got kidney disease, exacerbated by having massive kidney stones for many years (long predating the diabetes), many kidney infections, taking ibuprofen too often for too long, and the like. Now I’m on the transplant list and doing peritoneal dialysis. But I can eat a normal (although diabetic-restricted) meal, and drink a glass of wine with dinner, and I would not trade that ability and do it all over again with weight loss surgery if I were offered the chance.

    It is up to the individual diabetic to decide what her priorities and values are. Paternalism, as is seen from far too many doctors treating diabetics, is insulting and ultimately harmful, as it will make people rebel.

  47. Ivyfree
    Ivyfree January 26, 2008 at 1:32 am |

    As a formerly Type 2 diabetic who lost the diabetes, along with 100 lbs, with a lap-band that I fought for for two years- finally achieving insurance approval when the diagnosis of diabetes convinced even my insurance company that I was getting sicker, not weller, during the delay- I appreciate Kevin Keith’s common sense response, above. Know about nutrition? Sure, I did the diet thing for decades. Know about risks of surgery? Damn straight I do- I’m a nurse. My uncontrolled hypertension is controlled. My sleep apnea is significantly better. My energy level has skyrocketed. My depression is hugely better. Would I do it again, knowing all the risks? Without hesitation. Do I resent the implication that my decision to have bariatric surgery had to be ill-informed, shallow and lazy on my part? Damn straight I do.

  48. redhorse
    redhorse January 27, 2008 at 1:05 pm |

    I bake, and there is always some sugar in bread, of some sort, to feed the yeast. Different sugars have different chemical reactions and different impacts on the bread, from flavor to texture. I understand that corn syrup increases the keeping time on the bread, just as honey does. Salt in bread tightens up the gluten, and gives the bread a better structure. I like to use sea salt when I bake, because the trace minerals are like giving the yeast a vitamin pill.

    But I don’t use corn syrup in the bread I make at home. In fact, I don’t have any. I get disulfiram type reactions when I eat it. This last winter it has gotten worse and worse, and now I just have to eliminate it altogether.

    So I eat organic ketchup and organic spaghetti sauce while I wait for summer to make my own. I make my own desserts if I want something. We are probably going to get a small ice cream freezer so that I can make ice cream when I get the fancy for some and not have it make me ill. I’m fine at home, but finding somewhere I can eat safely in public is…problematic, sometimes. As was said above, corn syrup is in the damnedest places.

  49. redhorse
    redhorse January 27, 2008 at 1:05 pm |

    I bake, and there is always some sugar in bread, of some sort, to feed the yeast. Different sugars have different chemical reactions and different impacts on the bread, from flavor to texture. I understand that corn syrup increases the keeping time on the bread, just as honey does. Salt in bread tightens up the gluten, and gives the bread a better structure. I like to use sea salt when I bake, because the trace minerals are like giving the yeast a vitamin pill.

    But I don’t use corn syrup in the bread I make at home. In fact, I don’t have any. I get disulfiram type reactions when I eat it. This last winter it has gotten worse and worse, and now I just have to eliminate it altogether.

    So I eat organic ketchup and organic spaghetti sauce while I wait for summer to make my own. I make my own desserts if I want something. We are probably going to get a small ice cream freezer so that I can make ice cream when I get the fancy for some and not have it make me ill. I’m fine at home, but finding somewhere I can eat safely in public is…problematic, sometimes. As was said above, corn syrup is in the damnedest places.

  50. Jackie
    Jackie March 12, 2008 at 9:30 pm |

    I’m not surprised. The last time I spoke to an Australian in a chat room, about fat acceptance. They said, after I told them nobody fat would want to visit a country so full of hatred, “Good, we don’t want anymore fat Americans here.”

    I hope they enjoy getting zero tourism money. Nobody would want to vacation in a country that openly sponsors hate.

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