11 ms·

This article is disturbingly enthusiastic about bariatric surgery, an extreme procedure with limited success and serious side-effects. The long and short of it

by mcfunk 8y ago

This article is disturbingly enthusiastic about bariatric surgery, an extreme procedure with limited success and serious side-effects. The long and short of it is that we understand far too little about the human body and what drives weight gain and difficulty losing. For instance, there are complex health and immune issues (e.g., mast cell disorders) that can drive weight gain and difficulty losing in spite of healthy diets and high levels of activity (and researchers think mast cell disorders alone may affect 10% or more of the population, but was named only 5 years ago and is still poorly understood. What else could be similar that we just don't understand yet?) Beyond this, what we put in our bodies (various medicines, antibiotics, ingredients in processed foods, various pesticides etc, even artificial light) may have effects on our physiology that we don't yet have a strong understanding of. Our microbiomes are still a complete mystery to us, deeply impacting how and what we absorb from our food. The same food does not impact every body in the same way, period. Bariatric surgery is a band-aid over a gaping wound. Until we understand the complexities of human physiology at a more sophisticated level than a high-schooler in physics class (calories in, calories out just doesn't cut it) -- we are going to continue seeing public health impacts in the form of fat and disease -- which may often have underlying causes that the fat is simply the most visible symptom of. Edit: Seriously guys, is there any other area of science where people are so convinced that anecdotal and small-sample (both in terms of n and longitudinality) observations are valid? There's a huge market for delusion about fat, we're fighting that as much as we're fighting to learn more about the human body.

PaulHoule 8y ago
My sister in law had a lap band put in a decade ago and she recently had it taken out because of complications. It would be fair to say that it was a partial success and her doctor says that her case is not unusual and that lap bands haven't been as successful as had been hoped. As for explanations of the obesity epidemic note the timing -- it really took off in the 1980s, together with the social and political changes that we call "globalization" https://arxiv.org/abs/q-bio/0312011 https://arxiv.org/abs/q-bio/0312011 one possibility is that it was a change in social stressors, another that it was some environmental chemical introduced around that time. (eg. neonictinoid pesticides or glyphosate)
- 8ytecoder 8y ago
  Uh, it could also be the wealth increase that globalization brought? Food is more affordable now than ever before as well. I hope we don't throw around casually theories like that. These things usually are very complex and have multitudes of cause which may or may not center around a single event.
  - deleted 8y ago
    [deleted]
cpymchn 8y ago
Agree. 100%.
jtmcmc 8y ago
bariatric surgery has around a 68%~ success rate (as in hits goal weight) and around a 2% total failure rate (all weight gained back) it is by far the most effective weight loss intervention that exists by miles and miles. There are also a variety of surgeries with varying side effects and risk profiles from sleeve gastrectomy to something like a duodenal shift. It's definitely the case that this is not root causing the issue. There are probably many root causes to increasing obesity with many probably centered around the creation, easy availability, and marketing of calorie dense foods that do not satiate, however, bariatric surgery is something an individual can do while changing most of the root causes requires vast institutional changes.
aantix 8y ago
"We’re barely using the best tool we have to fight obesity" https://www.vox.com/science-and-health/2017/12/7/16587316/bariatric-surgery-weight-loss-lap-band https://www.vox.com/science-and-health/2017/12/7/16587316/ba... Not all bariatric surgeries are the same. The lap band doesn't perform well long term. The Roux-en-Y procedure is one of the very few obesity treatments that carry long-term success, where the patients keep the lost weight off. Waiting around for a better understanding is crazy, given the health complications are occurring now. Quality of life increases. Medications are eliminated or reduced. Long-term mortality is reduced (https://www.nejm.org/doi/full/10.1056/NEJMoa066603 https://www.nejm.org/doi/full/10.1056/NEJMoa066603 )
- teekert 8y ago
  Pretty radical solutions for a cultural problem. I wonder, maybe long term mortality is reduced but as long as you don't change to eating good food you will be missing out on vital substances, will you really grow old healthily by just eating less of the same crappy food?. Wouldn't it be easier to just focus on eating high fiber food like muesli and yogurt? That stuff keeps me stuffed for hours and hours.
  - aantix 8y ago
    >that stuff keeps me stuffed for hours and hours But.. you’re not 400 pounds with requirement to lose half your body weight, and keep it off for the rest of your life? And this is a requirement that these patients have obviously never been successful at. And they’ve probably done, and failed, long term, at most diets.
hallidave 8y ago
I recently read The Obesity Code by Dr. Jason Fung and in it he states that bariatric surgery is little more than surgically enforced fasting. Most people can fast without doing the surgery. I highly recommend the book. It's more like a science book about dieting than a diet book. Now that I understand that when I eat is as important as what I eat, I've been able to lose 20 pounds (and still going). And, yes, sugar (especially fructose) and refined carbs are bad.
- Daegalus 8y ago
  I read the book too and it was very good. More of a easy to read research paper than a fad diet. And makes a lot of sound conclusions. I adjusted my eating accordingly also and have lost weight. The only issue is I had to add a morning bite of something (i knwo this breaks the fast) but it kickstarts my metabolism. I follow everything else and only eat 2 meals and keep them close to maximize my fasting time. 15 lbs and counting. It has also been helping with portion control as a side effect. I dont eat as much anymore
- babyslothzoo 8y ago
  > Most people can fast without doing the surgery. Very few fat people have that level of self control. That's why they're fat in the first place.
  - qnsi 8y ago
    I think a lot of people can fast, but are never told to try this. Most people are recommended to eat 5 meals 300kcal each - and this is hard to do. Tell them to fast for 18h and eat in 6h window without calorie counting (but no shit food) and I would guess more people can do it.
    - RPLong 8y ago
      All that does is attach a ritual to the fasting process. People start to think that it's the ritual doing the work, but really it's the calorie restriction. Again and again, study after study proves that restricting calories to 700 calories reverses diabetes in obese people and in fact cures their obesity, too. It's no surprise that people who put on 100+ pounds of extra weight once would tend to put on 100+ pounds of extra weight a second time. But it's silly to claim that there is an underlying medical reason it's happening. The body gets used to whatever conditions you face. Human beings have thrived in the Arctic Circle, the North African deserts, and everywhere in between. Obese people have accustomed themselves to an obese lifestyle. If they can make a permanent break and embrace the lifestyle of a person with normal weight then they can stay skinny forever. In the end, most people just don't want to exercise 2+ times per day and limit their portion sizes. So they don't.
austincheney 8y ago
I know somebody who got bariatric surgery and ended up mega fat again a year later. Obesity is often not a deliberate choice, but it is a product of lifestyle decisions in almost all cases. Even though I have never been overweight last year I lost 25 pounds in 3 months by eating more food, not working out, and vastly increasing my fat intake. The secret sauce was eliminating carbs 6 days a week and slightly increasing my water intake. Avoiding drugs also helps including caffeine and nicotine.
- aantix 8y ago
  The lap band's long term performance is terrible - the sleeve and Roux-en-Y perform well long term with most patients keeping the weight off even 10 years later. Weight loss isn't the fundamental issue at play - it's permanent weight loss. Most individuals in their life are able to clean up their diets enough to lose weight, but maintaining that weight loss indefinitely for a lifetime, an overwhelming majority fail at it.
Reedx 8y ago
It's not that complicated in most cases. Eat less garbage (sugar especially - cutting out soda and juice is a good start) and be more active. You'll almost certainly lose weight and be healthier. The key is knowing what foods to eat and what to avoid. Then making it a lifestyle change, not bandaids or temporary diets.
- qnsi 8y ago
  Have you lost weight doing this method?
  - orwin 8y ago
    I've lost ~15 pound by cutting sugar, pasta and white bread. I also eat smaller portions overall, but i think this is a side effect.
  - Reedx 8y ago
    Yeah, though I took it further, cutting out all the junk at once. No burgers, fries, chips, donuts, ice cream, soda, etc. Basically all my favorites gone, heh. At the same time I started going to the gym 5-6 days/wk (~30mins/day). The result was losing 40 pounds in 3 months and feeling a lot better. Going to that extreme isn't necessary, though it did have some helpful side effects: - It reset my taste buds. Afterward sugary things tasted ridiculously sweet. - No longer craved sugar. - Portion sizes got a lot smaller. I distinctly remember feeling light on my feet and having a lot more energy. This was a decade ago. I kept off most of the weight, but ended up regaining 10 of the 40 as I reintroduced too much junk food.
gore90- 8y ago
"(calories in, calories out just doesn't cut it)" Why not? There is not some amazing mystery to why so many people are overweight. They eat more food (energy) than there body uses. Possibly over a long period of time. Just look at people's shopping carts at the grocery store. Yes we understand so little of the body's biological processes but that doesn't mean CICO is not an extremely useful idea and something to put into action.
- randomFacts 8y ago
  The mystery is in why some people eat more than they need and others don't. It's easy to say eat less calories, but until we solve the underlying biological reasons why certain people get full before overeating and don't gain weight and why certain people are always regaining lost weight your solution isn't going to help very many people.(Hint, see the satiety signals and hunger hormone comment I made lower down.)
  - dsego 8y ago
    There is a new trend of carnivore diets and I've noticed a lot of testimonials on youtube, where people swear they can eat as much meat as they want and still lose weight. Also some supposedly cured inflammations and other issues, probably because eating only meat is an extreme elimination diet.
    - virtuallynathan 8y ago
      It is however a very tasty elimination diet. I've tried it; ate all kinds of beef, lamb, pork, and fish: muscle meat, liver, roe, eggs, and somes dairy. Re: inflammation - I don't know what my hsCRP was beforehand, but during this experiment it was below the detectable range; all other inflammatory markers were low as well (insulin, IFG-1, fibrinogen, homocysteine, ferritin). I was only hungry about once a day, and leaned out quite a bit.
- falcolas 8y ago
  How many calories are you taking in? The answer is: It depends. There's a huge number of factors involved in simply identifying the number of calories present in the food we eat. Some studies show as much as a 20% difference in what was on the label and the actual caloric content. And that doesn't even account for how many calories are actually absorbed by the body - a value which has even more confounding factors. How many calories are you expending? The answer is: It depends. How (warm|cold) is it? What's your average body temperature? How much clothing do you wear? What's your genetic makeup? Doing a lot of thinking? What's your current exercise regimen? Is your body in state X where it burns (more|less) calories than state Y? Are you sick? Calories in and calories out sounds good on paper and seem obvious to an engineers mind, but if you can't tell how many calories are involved on each side of the equation, it's a meaningless measure.
masonic 8y ago
When it is successful, much success can be attributed to the resulting decrease in ghrelin, which is mostly an accident of physiology (the part removed/constrained is chosen for surgical simplicity, and it happens to have higher ghrelin secretion).

by mcfunk 8y ago

PaulHoule 8y ago

My sister in law had a lap band put in a decade ago and she recently had it taken out because of complications. It would be fair to say that it was a partial success and her doctor says that her case is not unusual and that lap bands haven't been as successful as had been hoped. As for explanations of the obesity epidemic note the timing -- it really took off in the 1980s, together with the social and political changes that we call "globalization" https://arxiv.org/abs/q-bio/0312011 https://arxiv.org/abs/q-bio/0312011 one possibility is that it was a change in social stressors, another that it was some environmental chemical introduced around that time. (eg. neonictinoid pesticides or glyphosate)

8ytecoder 8y ago
Uh, it could also be the wealth increase that globalization brought? Food is more affordable now than ever before as well. I hope we don't throw around casually theories like that. These things usually are very complex and have multitudes of cause which may or may not center around a single event.
- deleted 8y ago
  [deleted]

cpymchn 8y ago

Agree. 100%.

jtmcmc 8y ago

bariatric surgery has around a 68%~ success rate (as in hits goal weight) and around a 2% total failure rate (all weight gained back) it is by far the most effective weight loss intervention that exists by miles and miles. There are also a variety of surgeries with varying side effects and risk profiles from sleeve gastrectomy to something like a duodenal shift. It's definitely the case that this is not root causing the issue. There are probably many root causes to increasing obesity with many probably centered around the creation, easy availability, and marketing of calorie dense foods that do not satiate, however, bariatric surgery is something an individual can do while changing most of the root causes requires vast institutional changes.

aantix 8y ago

"We’re barely using the best tool we have to fight obesity" https://www.vox.com/science-and-health/2017/12/7/16587316/bariatric-surgery-weight-loss-lap-band https://www.vox.com/science-and-health/2017/12/7/16587316/ba... Not all bariatric surgeries are the same. The lap band doesn't perform well long term. The Roux-en-Y procedure is one of the very few obesity treatments that carry long-term success, where the patients keep the lost weight off. Waiting around for a better understanding is crazy, given the health complications are occurring now. Quality of life increases. Medications are eliminated or reduced. Long-term mortality is reduced (https://www.nejm.org/doi/full/10.1056/NEJMoa066603 https://www.nejm.org/doi/full/10.1056/NEJMoa066603 )

teekert 8y ago
Pretty radical solutions for a cultural problem. I wonder, maybe long term mortality is reduced but as long as you don't change to eating good food you will be missing out on vital substances, will you really grow old healthily by just eating less of the same crappy food?. Wouldn't it be easier to just focus on eating high fiber food like muesli and yogurt? That stuff keeps me stuffed for hours and hours.
- aantix 8y ago
  >that stuff keeps me stuffed for hours and hours But.. you’re not 400 pounds with requirement to lose half your body weight, and keep it off for the rest of your life? And this is a requirement that these patients have obviously never been successful at. And they’ve probably done, and failed, long term, at most diets.

hallidave 8y ago

I recently read The Obesity Code by Dr. Jason Fung and in it he states that bariatric surgery is little more than surgically enforced fasting. Most people can fast without doing the surgery. I highly recommend the book. It's more like a science book about dieting than a diet book. Now that I understand that when I eat is as important as what I eat, I've been able to lose 20 pounds (and still going). And, yes, sugar (especially fructose) and refined carbs are bad.

Daegalus 8y ago
I read the book too and it was very good. More of a easy to read research paper than a fad diet. And makes a lot of sound conclusions. I adjusted my eating accordingly also and have lost weight. The only issue is I had to add a morning bite of something (i knwo this breaks the fast) but it kickstarts my metabolism. I follow everything else and only eat 2 meals and keep them close to maximize my fasting time. 15 lbs and counting. It has also been helping with portion control as a side effect. I dont eat as much anymore
babyslothzoo 8y ago
> Most people can fast without doing the surgery. Very few fat people have that level of self control. That's why they're fat in the first place.
- qnsi 8y ago
  I think a lot of people can fast, but are never told to try this. Most people are recommended to eat 5 meals 300kcal each - and this is hard to do. Tell them to fast for 18h and eat in 6h window without calorie counting (but no shit food) and I would guess more people can do it.
  - RPLong 8y ago
    All that does is attach a ritual to the fasting process. People start to think that it's the ritual doing the work, but really it's the calorie restriction. Again and again, study after study proves that restricting calories to 700 calories reverses diabetes in obese people and in fact cures their obesity, too. It's no surprise that people who put on 100+ pounds of extra weight once would tend to put on 100+ pounds of extra weight a second time. But it's silly to claim that there is an underlying medical reason it's happening. The body gets used to whatever conditions you face. Human beings have thrived in the Arctic Circle, the North African deserts, and everywhere in between. Obese people have accustomed themselves to an obese lifestyle. If they can make a permanent break and embrace the lifestyle of a person with normal weight then they can stay skinny forever. In the end, most people just don't want to exercise 2+ times per day and limit their portion sizes. So they don't.

austincheney 8y ago

I know somebody who got bariatric surgery and ended up mega fat again a year later. Obesity is often not a deliberate choice, but it is a product of lifestyle decisions in almost all cases. Even though I have never been overweight last year I lost 25 pounds in 3 months by eating more food, not working out, and vastly increasing my fat intake. The secret sauce was eliminating carbs 6 days a week and slightly increasing my water intake. Avoiding drugs also helps including caffeine and nicotine.

aantix 8y ago
The lap band's long term performance is terrible - the sleeve and Roux-en-Y perform well long term with most patients keeping the weight off even 10 years later. Weight loss isn't the fundamental issue at play - it's permanent weight loss. Most individuals in their life are able to clean up their diets enough to lose weight, but maintaining that weight loss indefinitely for a lifetime, an overwhelming majority fail at it.

Reedx 8y ago

It's not that complicated in most cases. Eat less garbage (sugar especially - cutting out soda and juice is a good start) and be more active. You'll almost certainly lose weight and be healthier. The key is knowing what foods to eat and what to avoid. Then making it a lifestyle change, not bandaids or temporary diets.

qnsi 8y ago
Have you lost weight doing this method?
- orwin 8y ago
  I've lost ~15 pound by cutting sugar, pasta and white bread. I also eat smaller portions overall, but i think this is a side effect.
- Reedx 8y ago
  Yeah, though I took it further, cutting out all the junk at once. No burgers, fries, chips, donuts, ice cream, soda, etc. Basically all my favorites gone, heh. At the same time I started going to the gym 5-6 days/wk (~30mins/day). The result was losing 40 pounds in 3 months and feeling a lot better. Going to that extreme isn't necessary, though it did have some helpful side effects: - It reset my taste buds. Afterward sugary things tasted ridiculously sweet. - No longer craved sugar. - Portion sizes got a lot smaller. I distinctly remember feeling light on my feet and having a lot more energy. This was a decade ago. I kept off most of the weight, but ended up regaining 10 of the 40 as I reintroduced too much junk food.

gore90- 8y ago

"(calories in, calories out just doesn't cut it)" Why not? There is not some amazing mystery to why so many people are overweight. They eat more food (energy) than there body uses. Possibly over a long period of time. Just look at people's shopping carts at the grocery store. Yes we understand so little of the body's biological processes but that doesn't mean CICO is not an extremely useful idea and something to put into action.

randomFacts 8y ago
The mystery is in why some people eat more than they need and others don't. It's easy to say eat less calories, but until we solve the underlying biological reasons why certain people get full before overeating and don't gain weight and why certain people are always regaining lost weight your solution isn't going to help very many people.(Hint, see the satiety signals and hunger hormone comment I made lower down.)
- dsego 8y ago
  There is a new trend of carnivore diets and I've noticed a lot of testimonials on youtube, where people swear they can eat as much meat as they want and still lose weight. Also some supposedly cured inflammations and other issues, probably because eating only meat is an extreme elimination diet.
  - virtuallynathan 8y ago
    It is however a very tasty elimination diet. I've tried it; ate all kinds of beef, lamb, pork, and fish: muscle meat, liver, roe, eggs, and somes dairy. Re: inflammation - I don't know what my hsCRP was beforehand, but during this experiment it was below the detectable range; all other inflammatory markers were low as well (insulin, IFG-1, fibrinogen, homocysteine, ferritin). I was only hungry about once a day, and leaned out quite a bit.
falcolas 8y ago
How many calories are you taking in? The answer is: It depends. There's a huge number of factors involved in simply identifying the number of calories present in the food we eat. Some studies show as much as a 20% difference in what was on the label and the actual caloric content. And that doesn't even account for how many calories are actually absorbed by the body - a value which has even more confounding factors. How many calories are you expending? The answer is: It depends. How (warm|cold) is it? What's your average body temperature? How much clothing do you wear? What's your genetic makeup? Doing a lot of thinking? What's your current exercise regimen? Is your body in state X where it burns (more|less) calories than state Y? Are you sick? Calories in and calories out sounds good on paper and seem obvious to an engineers mind, but if you can't tell how many calories are involved on each side of the equation, it's a meaningless measure.

masonic 8y ago

When it is successful, much success can be attributed to the resulting decrease in ghrelin, which is mostly an accident of physiology (the part removed/constrained is chosen for surgical simplicity, and it happens to have higher ghrelin secretion).