I went to dinner with a good friend a couple of months ago. She seemed antsy and restless while we were eating. Then, excitedly, she announced, “I’m on Weight Watchers!” Wait, what? She knows me well. She’s heard me rail and rant about the failure of dieting. She’s listened to me talk about FA. And yet she still had a thrill in her voice when she announced this to me. As I looked at her incredulously, she responded, “I know I only have a 5% chance, but this time I’m doing it for my health!”
As I stared at her in amazement, a light bulb went on in my head: “but it’s for my health” is often used as an almost mystical, magical talisman to ward off the gods of failed diets. There exists a belief that somehow, if a person changes their motivation, they’ll lose weight. I believe this myth is behind the entire Obesity Epidemic. I’ve talked before about the fact that we were starting to accept that diets don’t work in the early 1990s - until, that is, someone came up with dieting for health. Then, as a society, we once again embraced it wholeheartedly. It would work this time, because it’s “for my health.”
I collect stories of those who successfully keep the weight off: at least 50 pounds for 5 years. So far, in seven years, I have collected seven stories. Of those seven, five gained the weight while pregnant and one while in an abusive relationship. Before these events, none had ever had weight problems; none had ever dieted. Each of them went on one diet and lost the weight, never having to worry about dieting again. Of the one other, she lost weight because of a very potent medicine, and she believes the weight would come back on if she stopped the meds.
When they are talking about that 5%, they are not talking about those of us who dieted for years. They are not talking about us who started out fat. They are not talking about those of us with three (in my case) fat grandparents. They are talking about people who gained weight during a pregnancy, or a short illness, or a period of depression. They are talking about people who are naturally thin - people who normally don’t have to deal with fat and who just got fat for a little while. I have heard that if you have been on more than three diets, your chances of losing weight are astronomically low.
I have been rabidly anti-dieting, and now I’m trying to change that. I’m trying to have more compassion. I know how hard it is to be a size 26 in this world; I imagine being bigger is significantly harder. Even as a deathfattie, I have privilege compared to those who cannot fit in an airplane seat or buy clothes in a brick and mortar store. I am not walking in your shoes, so I can’t know what your life is like. Yet, I can't help but discourage it BECAUSE IT DOESN'T WORK!
I watch friend after friend diet for their health and end up unhealthier in the end - and usually fatter. To add insult to injury, instead of seeing the diet as a failure, fat people usually see themselves and their bodies as failures. Be honest. How many of you have dieted time and time again only to end up fatter and hating yourself for it? How many of you who are in that but-I'm-so-fat-I'm-unhealthy place BECAUSE you dieted?
This is the thing: we have a tendency to fool ourselves. We tell ourselves it's for our health. However, if that were true, then HAES would actually be a better option. We tell ourselves we only want to lose 10%. I have found (a phenomena noted in Hirshmann and Munter’s When Women Stop Hating Their Bodies) that I don’t want to stop until I’m what society thinks is perfect. A little weight loss almost always leads to the desire for more.
In my experience, most people who say they want to lose weight for their health, just want to lose weight. If it is really about health, how about trying HAES? HAES has been proven to improve health no matter where you start out.
If you are in that place of thinking that your health sucks because of your weight, I feel for you. If you need to try one more diet, do. If you can, keep reading FA stuff while you diet. If you can’t, come back if it doesn’t work. If you are thinking about some kind of WLS, I want to encourage you to throw yourself into HAES and FA for one year - just one year. Give it the best try you can. If it doesn’t work for you, go have WLS next year.
I’m not anti-dieting because I want people to remain fat. I’m anti-dieting because it doesn’t work. “But it’s for my health” doesn’t make the odds any better. Remember: you did not fail; the diet did.
A story called "Fat Stigma Spreads Around the Globe," by Tara Parker-Pope, was on the front page of the New York Times this morning. It reports on a new study in the April 2011 issue of Current Anthropology, Body Norms and Fat Stigma in Global Perspective.
The news is bad.
Dr. Brewis said she fully expected high levels of fat stigma to show up in the “Anglosphere” countries, including the United States, England and New Zealand, as well as in body-conscious Argentina. But what she did not expect was how strongly people in the rest of the testing sites expressed negative attitudes about weight. The results, Dr. Brewis said, suggest a surprisingly rapid “globalization of fat stigma.”
“The change has come very, very fast in all these places,” she said.
However, but the coverage is amazingly even handed.
...what appears to have changed is the level of criticism and blame leveled at people who are overweight. One reason may be that public health campaigns branding obesity as a disease are sometimes perceived as being critical of individuals rather than the environmental and social factors that lead to weight gain.
“A lot of the negative health messages have a lot of negative moral messages that go with them,” Dr. Brewis said.
Marianne Kirby of Orlando, Fla., who writes the fat-acceptance blog TheRotund.com, said the apparent spread of fat stigma was not surprising, given the global push to brand obesity as a major health threat.
“The fundamental message we’re putting into the world is that fat people deserve shame for their own health,” said Ms. Kirby, co-author of the book “Lessons From the Fat-o-Sphere.” “We’ve been pushing this message for a long time. I don’t think anyone is immune to it.”
Wow! This article includes a quote from Marianne Kirby. The author has come to us - fat acceptance advocates - for balance. This is truly amazing to me. Maybe we really are making a difference.
From the Daily Mail:
Sex In The Nation, a survey of 4,000 people, found that 29 per cent of women cited feeling that they looked fat as a reason for avoiding sex, with a further 23 per cent blaming embarrassment about their ‘wobbly bits’.
The figures for male respondents were eight per cent and 11 per cent respectively.
The biggest passion-killer of all was tiredness, a reason 72 per cent of women said they had given their partners, followed by feeling unattractive (34 per cent), illness (33 per cent) and stress (32 per cent).
Although this story is a couple of weeks old and is based on a study conducted by a manufacturer of herbal remedies for low libido (yeah, I'm sure it's top of the line science), it seems like a good jumping off point for a discussion of libido, body image, and shame.
The news outlets are framing this as being about weight, but I'm sure that most BFB readers are thinking the same thing I did: it's about negative body image, and negative body image is not really linked to weight. Sure, fat people are encouraged to have poor body image, and that bleeds into the general population as well. Everyone seems to think they're too fat. But being down on yourself because to think you're fat and actually being fat are two different things. Two things that often don't go together.
We fat acceptance people actively fight poor body image. We break down the aesthetics that society tries to force-feed us so that we can see our own beauty. We work on accepting and connecting with our bodies.
But this loss of libido is about something else too: shame. Shame, and perhaps a weird displacement in sexual desire. This study suggests that most women and some men have their libidos linked to (let me try to get this straight) how they perceive their partners perceiving them. Not how attractive they find their partners. How attractive they think they are in light of the societal ideals they've been exposed to.
How did it come to this? And can those of us who've successfully improved our body image and/or have at least partially decoupled it from our sex drives offer some advice and insight to people who are struggling with these issues?
The Chronicle-Telegram, an Ohio paper, reports that a local man died after being encouraged to crash diet by Army recruiters- Death from dieting: Coroner says crash regimen to make weight killed Army recruit.
Wilsey, 20, died on March 3 of acute cardiac dysrhythmia from an electrolyte imbalance caused by extreme dieting that included binging and purging, according to Lorain County Coroner Paul Matus.
Wilsey’s mother, Lora Bailey, said her son was determined to join the Army and lost about 85 pounds in 3½ months in hopes of fitting into a bomb disposal suit.
Midway through the process, her son, who was more than 6 feet tall, was told to step up his efforts, she said.
He went on an 800-calorie-a-day diet and began an intensive exercise regime that involved wearing a waist band as well as garbage bags or a scuba suit under two sets of sweat pants and a sweat shirt while he exercised.
“At that time, he was also told, coached, suggested, prodded — whatever word needs to be used — that ‘If you eat a big meal, it is OK to vomit that back up,’” she said.
He was a football player and wrestler in high school, and he did so well on the army entry exams that the recruiter wanted him to enroll in a training program for an elite bomb squad rather than training as a medic, as he had intended.
This was a fit, intelligent young man who wanted to serve his country by saving lives rather than taking them. What a horrible, senseless loss.
Obesity epidemic? No, we are on the verge of a FATPOCALYPSE!
Brothers and sisters, the end is thigh. Let the veil be lifted. The light of knowledge will shine upon the world and lo! A new age of fat acceptance will dawn.
There's a new study that fails to support the theory that weight loss surgery cures type II diabetes. MedPage Today published an article on it, entitled 'AACE: Bariatric Surgery May Just Mask Diabetes.'
A larger study was posted on the same topic in 2009, there were earlier studies with the same conclusions, and I've always suspected that these studies are right; that WLS doesn't cure diabetes.
We all know what kind of money and influence is behind the people promoting weight loss surgery; the surgeon's groups and the drug companies that manufacture the devices. Surgery candidates want to believe that WLS is worth the risks, because they want the social rewards that come with being thin. If they have or fear getting diabetes, then the claim that WLS "cures diabetes" can be a powerful influence.
But it doesn't really make sense that WLS cures diabetes, does it?
This is how I see it. No doubt it's an oversimplified way of looking at things. I'm not a medical professional, but there are people in my family with type II diabetes and I'm at risk of getting it myself, so I've done a lot of reading.
Type II diabetes is primarily a genetic syndrome, although the easiest way to diagnose and track it is to measure blood sugar. However, if someone can't eat a normal meal - if they're basically starving - then their blood sugar is not going to be high even if they're diabetic. If a diabetic is constantly running a calorie deficit (as they would after WLS), then the fact that their cells aren't responding to insulin - which tells the cells to store fat - isn't really going to matter, because they're losing fat stores, not adding to them. Does that mean that the diabetes is cured? No. As soon as their weight stabilizes and they go back to sometimes using energy and sometimes storing it, then the diabetes will once again become easy to detect.
From the Medpage article:
The researchers also cited flaws in the 621 studies involved in a meta-analysis by Buchwald et al, which concluded that bariatric surgery was a cure for diabetes.
They said most of the studies were retrospective, single-armed, and made up of relatively young women. Also, only 1.6% of them provided Class I evidence.
Marina concluded that HbA1c and fasting blood glucose measurements aren't sufficient criteria to establish a "curing" of type 2 diabetes after gastric bypass surgery.
- The new study-
American Association of Clinical Endocrinologists, Marina AL, Trence DL "Is diabetes mellitus really cured by gastric bypass surgery?" AACE 2010; Abstract 210.
- The older study-
Roslin M, et al "Abnormal glucose tolerance testing following gastric bypass" Surg Obesity Related Dis 2009; 5(3 Suppl): Abstract PL-205.
Kirstie Alley. Okay, so she's been a yo-yo dieting exhibitionist whose body negativity and obsession with weight loss has sometimes made me cringe - and I never even watched any of her weight-related shows.
But I like her as a comedienne (remember Cheers?) and it can't be denied that she is tearing up the dance floor as a 60-year-old -- 60! -- fat chick in this sequence from Dancing with the Stars.
So, go go go with the (non-weight focused) comedy and dancing, Kirstie! Keep on living fully and joyfully in the body you have. It's a truly beautiful thing to see happening.
Just wanted to point out that I've added the NAAFA Press Releases Feed to the column on the left of the BFB layout. Now you can access it as easily as the fatophere blog feeds. I've also hyperlinked the names of the feeds in addition to the icons, to make them easier to click.
I like to open the feeds in new tabs to read them. Here's how to do that in various browsers:
- On Safari, the shortcut is apple key-click.
- On Google Chrome, the shortcut is control-left click.
- On Explorer, Opera and Firefox, it's shift-left click
Gastric bands have been in use in Europe since the early 1990s. That begs the question "Where's the data on the long term safety and effectiveness of these devices?" Well, a study called Long-term Outcomes of Laparoscopic Adjustable Gastric Banding has been published in the Archives of Surgery, (Himpens et al., Arch Surg.2011; 0: 2011451-6.) based on that long term European data.
This is being reported on in The Los Angeles Times: Study Questions Lap-Band's Long-Term Effectiveness and on Bloomburg.com, a financial website: Obesity Lap Bands Cause More Complications Than Weight Loss, Study Finds.
Guess what? Lap bands are neither safe nor effective for most people. From the Bloomberg article:
About 60 percent of the 82 patients with the device, Allergan Inc.’s Lap-Band, followed over 12 years or more needed additional operations, according to a study by Belgian researchers published online today by the Archives of Surgery. The minimally invasive surgery led to weight loss of 18 percent in 70 patients where data was available...
Twenty-three patients, or 1 in 3 who responded to the survey, experienced band erosion, diagnosed after a median of four years, the study found. Almost 50 percent of the patients lost their bands within nine years.
A 60% re-operation rate. 18% or less weight loss - not even enough to make an average height person with a BMI of 35 overweight rather than obese. This isn't news to a lot of people in the Fatosphere, including Bri of Fat Lot of Good. However, it's always good to be able to cite studies.
Kelly Gneiting broke the Guinness World Record for "Heaviest Person to Complete a Marathon" by crossing the finish at the Los Angeles Marathon on Sunday.
The former U.S. sumo champion, who weighed in at Dodger Stadium on Sunday morning at exactly 400 pounds, finished the race in 9 hours, 48 minutes and 42 seconds.
Gneiting, of Ft. Defiance, Ariz., walked the last 18-plus miles of the race after jogging through the first 8 miles.
Shaunta at Llve Once, Juicy has written a post about the Anger Kelly Gneiting inspires among runners, and she makes some excellent points.
Reading the media coverage of Kelly's accomplishment, I was struck by the condescending tone in a lot of the articles. There are the usual fat-ha-ha plays on words and a very prominent focus on how difficult and painful the marathon was for Kelly; how his feet hurt and he had blisters. However, I'm pretty sure that marathons are difficult and painful for everyone. Looking at the ESPN footage of Kelly finishing, he looks tired but in control - and there are plenty of people behind him.
Now, the L.A. marathon has a 26.2 mile course. The top runners finish in a little over 2 hours. The average time for people who finish the race is 4-6 hours. For the 2011 L.A. Marathon, the average was 5 hours 16 minutes, and the last participant came in at 12 hours, 23 minutes.
Kelly was slowed down by his weight, no doubt.
However, here's a controversial thing to say: if we fat people can keep up with lighter people, showing no more strain than they do, then that means that we are stronger and more cardiovascularly fit than they are. How many people can walk 26 miles, let along run the first 8? How many people can do it without having a very low fat percentage? There are comments on the stories about Kelly talking about "strain on his heart." What people seem to forget is that the heart is a muscle. If you're heavy and active, then it gets to be big and powerful (and when you lose weight, it shrinks - this is why so many people have heart attacks while regaining weight they've lost).
If you're a thin fitness type reading this and shaking your head, then I have a challenge for you: attach enough weight to your body to make you equal in mass to an active fat person of your acquaintance. Then try to keep up with him or her. Frankly, I doubt that either you or I could walk a block, let alone a marathon (let alone run the first 8 miles), with enough added weight to equal Kelly G.
If you want to know how the performance of the type of thin, active folks who are considered fittest responds to added weight, then take a look at the military finish times for the Baton Memorial Death March, where participants can compete while wearing 35 pound backpacks. When you compare military men with and without packs, the packs add over an hour to the median time. Incidentally, the median time with the packs is similar to Kelly's time in the LA Marathon. Remember, these are the completion times for athletic members of the U.S. military who are only carrying an extra 35 pounds. Wonder how far those military guys would get with 200 pound backpacks.
This is a real athletic accomplishment, not just luck or some kind of fuzzywuzzy-newsy "triumph of the human spirit." Kelly trained hard, he did something that, in terms of weight, was more difficult for him to do than for any of the other almost 20,000 participants in the marathon, and he did it with grace and dignity. Cheers, Kelly!
Oh, and there's a beautiful photo of Kelly demonstrating his strength, flexibility and balance (by Mariah Tauger of the L.A. Times) here . I wish I could have used it to illustrate this post, but that would be a copyright violation. (curses!)
I've been planning to put together a post discussing specifics of WLS risks, side effects, and complications as a follow-up to our recent series on FDA approval of the lap band for lower BMIs. I want to give definitions of the medical terms and provide links to studies. It'll take a bit of research and a bit of time to put together.
So for now, I give you this new emergency room poster, published by the American Society for Metabolic and Bariatric Surgery: Clinical Pearls for the Emergency Care of the Bariatric Surgery Patient (that's a link to the full pdf).
WLS is becoming more common, and as a result emergency rooms are having to deal with more WLS complications; serious and life threatening damage to patients' health. This poster is being provided to hospital emergency rooms so that they can recognize some of the most common issues. Let's take a quick look at what it has to say about these issues, shall we?
- Intra-Abdominal Bleeding: "Bright Red Blood Oral or Rectal, Melena, Bloody Drainage, Tachycardia, Hypotension, Fainting" - this can end in death
- Leaks and Sepsis: often requires surgery; can be deadly
- Obstruction: "Closed loop obstruction and internal hernias are a risk after gastric bypass and may be lethel if dead bowel. Bowel can become ischemic in six hours."
- Pulmonary Embolism: blockage of the main artery of the lung - can be deadly
- Vomiting ± Abdominal Pain: "Vomiting associated with abdominal pain needs prompt surgical evaluation and observation until resolved or surgical exploration." - this can indicate a life threatening condition
- Abdominal Compartment Syndrome: "Progressive respiratory insufficiency, Renal failure, Intra-abdominal hypertension, Associated with end-organ failure..." Yes, this can kill you as well.
And bonus! Here are illustrations of some of the things that go wrong with gastric bands:
People like to say that being thinner automatically gives you better quality of life. Increasing your risk of this list of things happening to you... that isn't an improved quality of life. It's an increased risk of death - and a barrier to living fully. Oh, sure, they can probably save you if you make it to the emergency room in time, one with competent staff that have access to this information and time to go through all the steps. But, how much extra risk are to taking on if you (for example) travel to a foreign country where you don't speak the language and where emergency room staff won't recognize these symptoms? What if you want to go on a backpacking trip, and could easily end up in a situation where you can't get treated in time?
These things don't generally happen to people whose digestive systems haven't been surgically altered. If you look at the poster, just notice all the reasons they might have to cut you open for a second, third, or fourth time. Every single one of those experiences would be traumatic, painful, and time consuming to recover from, with a negative effect on your family and work life.
As fat people, our size doesn't necessarily prevent us from travelling anywhere in the world, going on backpacking trips, skiing, scuba diving, skydiving, or doing anything else we put our minds to. If we're not disabled and can access equipment that fits and is up to spec, we can do those things if want. However, people who try to lose weight through WLS are going to have to be careful for the rest of their lives, because they're always going to have these increased risks. Fat bodies can be healthy bodies. A post WLS body is always going to have been damaged.
Sp!ked is a British humanist/libertarian Internet magazine. They've published an article on the new study in the Lancet - the one that fails to support the theory that waist circumference and waist/hip ratio are more important than BMI for predicting risks (or indeed that any of those three pieces of information are useful when you know the numbers for blood pressure and cholesterol).
The article's called How the War on Obesity went Pear-Shaped. Having a very nice pear shape myself, I'm not a fan of "pear shaped" being used as a synonym for "wrong." HOWEVER, this is an excellent article. Here are two of my favorite paragraphs, but its worth it to follow the link and read the whole thing.
Since the anti-obesity campaign is allegedly motivated by scientific findings, it would seem reasonable and prudent to make doubly sure that those claims are factual and trustworthy. Yet, we continue to find that the case against obesity is significantly flawed. Not only are the claims of an obesity epidemic often wildly exaggerated, but the science linking weight to unfavourable mortality outcomes is also frequently nonexistent or distorted.
Obesity crusaders’ are what we call the individuals who manufactured the obesity-epidemic story in the first place and continue, through application of inherently flawed instruments, such as BMI and apple-body shapes, to misinform the public. They are a relatively small group of public-health officials in the US, the UK, the EU, and the World Health Organisation, assorted academics (very many with close ties to the weight-loss and pharmaceutical industry), the International Obesity Task Force, and a collection of so-called public-interest science groups.
The article has two authors: Patrick Basham, who directs the Democracy Institute and is a Cato Institute adjunct scholar, and John Luik is a Democracy Institute senior fellow. The fatosphere has a liberal bias (as do I). However, on this issue, the liberals are failing us and the libertarians are talking sense.
From the Associated Press, via Yahoo News: US life expectancy surpasses 78, a new record.
This is in spite of the fact that, according to the Centers for Disease Control, 34% of Americans are classified as overweight and an additional 34% are classified as obese. And it's a horrible, scary, deadly EPIDEMIC - an epidemic that is now affecting 68% of us. Why are we not dying earlier? Where, I ask, are the piles of dead fat people?
Despite decades of hand wringing over how increasing rates of overweight and obesity are going to decrease life expectancy in the U.S., life expectancy keeps stubbornly increasing.
Is it because fat people are benefitting from advances in medicine? If we are, it's being mitigated by a lot a societal forces that would tend to damage our health.
Fat Americans are charged more for or refused health insurance. Medical professionals tend to want to treat our body size rather than caring for our health. We are more likely than average to be poor and/or members of ethnic minorities that are discriminated against. We, as fat people, are discriminated against. Large numbers of us continue to subject ourselves to unhealthy and ineffective weight loss methods. Given this, it's a miracle that as a group, we aren't causing the national life expectancy to decrease.
Aren't we fat people wonderfully resilient?
Oh! And the same thing is happening in the U.K.
NOW Foundation's Love Your Body 2011 Poster Contest winners have been announced. The winning entry looks nice, but there's no hint that it's possible to love a larger than average body. The images in winning posters from past years have been perhaps slightly more fat-positive. Maybe. A little.
Of course, that's not really the point. The point is that all women are taught to hate their bodies.
Hollywood and the fashion, cosmetics and diet industries work hard to make each of us believe that our bodies are unacceptable and need constant improvement. Print ads and television commercials reduce us to body parts -- lips, legs, breasts -- airbrushed and touched up to meet impossible standards. TV shows tell women and teenage girls that cosmetic surgery is good for self-esteem. Is it any wonder that 80% of U.S. women are dissatisfied with their appearance?
Women and girls spend billions of dollars every year on cosmetics, fashion, magazines and diet aids. These industries can't use negative images to sell their products without our assistance.
Well, I can get behind that. However, how much cooler would it be if the "Love Your Body" poster made it clear that larger or (better yet!) bodies of all sizes, shapes and abilities are worth loving?
The deadline for next year's poster contest is December 3, 2011. Details are here. NOW tends to choose artwork depicting thin to average sized bodies. Let's make sure that isn't because it's the only kind of entry they get.
Paul Campos has an article in today's Daily Beast: Michelle Obama's Let's Move Campaign Is Helping Bullies
Some plum quotes:
The first lady would, no doubt, be horrified by the suggestion that her Let’s Move campaign, which is dedicated to trying to create an America without any fat kids, is itself a particularly invidious form of bullying. But practically speaking, that’s exactly what it is. The campaign is in effect arguing that the way to stop the bullying of fat kids is to get rid of fat kids.
And, on the necessity of public policy that is evidence based and risk-assessed:
Given our political climate, it’s more important than ever for liberals not to assume that a particular government initiative to stop something from happening is a good idea. Rather, we need to be reasonably certain that a) the something in question is actually happening; b) we know why it’s happening; c) we know how to stop it from happening; and d) the benefits of stopping it from happening are worth the costs...
The Let’s Move campaign fails this test spectacularly. It has had one notable success, however: According to a Pew Foundation poll, nearly three in five Americans now believe that the government should have “a significant role in reducing childhood obesity.”
Some other good articles on the same topic:
• Two Whole Cakes: Fat Children are to Blame for the Economy, Says Michelle Obama, by Lesley Kinzel
• Red No. 3: A Radical Idea, by Brian
• The Daily Caller: An open letter to First Lady Michelle Obama, Brandon Macsata (speaking for NAAFA)
• Slate: Leave the Fat Kids Alone, by Daniel Engber
• Dear Mrs. Obama, by Allison Dickson
• Live Once, Juicy: Do You Think Michelle Hears Us?, by Shaunta
• Newsweek: Fat Kids, Cruel World, by Lesley Kinzel
• The Huffington Post: Lessons From My Life as a Fat Kid, By Jane Shure
• And of course our own Fat Kids Targeted
This seems like a good time to give a heads up on "I Take Up Space," a series of articles that Pattie Thomas (author of "Taking Up Space,") has been writing for Psychology Today's web site. Her newest article, "Stigma is BIG Business," focuses on Allergen and the lap band.
It's a great article, and it includes some interesting numbers:
What Allergan calls "obesity intervention products" are expected to bring in $220 to 240 million in NET sales. That is what they will make beyond the cost of production. This expansion is estimated to have created a new market of over 26 million Americans, quite a significant boost to their potential sales...
Going from 15 million potential customers to 41 million customers is a 173.33% increase in a market in which Allergan basically has a monopoly. In other words, our government handed over to Allergan an incredible increase in market with a simple vote.
Other recommended links:
on Living ~400 lbs, there's a post on a new study that's - big surprise - being negatively spun in the press. Guess what? When you take other risk factors into consideration, BMI is not strongly linked to heart disease risk - even for apple-shaped people. Of course, the press is interpreting that as "Body shape has no impact on heart disease risk! If you're fat and pear shaped, you're still doomed!! Bwahahahaha!"
Talking about the US right now, obviously...
I wanted to write a quick, pat post about what FDA approval means and the effects it has on the use of medical devices (such as lap bands) and drugs.
I had a few points in mind:
- The FDA can take action to stop the sale of unapproved drugs and medical devices. However, drugs and devices that are approved for a particular group of patients or for a particular use may be prescribed "off label" by licensed physicians. That's why lap bands and similar devices are already being used in teenagers.
- However, FDA approval makes it much more likely that insurance companies will cover a particular treatment AND
- FDA approval will tend to decrease doctors', drug companies' and insurance companies' liability. In other words, when the FDA approves a drug or medical device, it is taking on some responsibility for its effectiveness and safety.
Those issues seemed pretty clear to me, based on my limited knowledge. However, I wanted to confirm them and to find out when an unapproved treatment might invite government legal action against a manufacturer, retailer, or practitioner. I hoped that this would involve half an hour of online research. Oh, how wrong I was.
Like a lot of government agencies, the way the FDA does its job is not always well documented and well defined. I'm not saying that they do a bad job, although many people agree that they're too much under the influence of drug industry stakeholders. It's the nature of government that the laws and regulations that assign responsibility aren't always clear or consistent, and the scope of action is dependent on limited resources.
Since I don't want to wait to post this until I've had time to research and write the equivalent of a university term paper, I'm going to post a few links and ask BFB commentators to add their insights.
- This post on the web site of the American Cancer Society is the most concise, straightforward, and comprehensive discussion of off-label use I've found.
- Here's a post on off-label use on the website of a doctors' liability insurance company.
- This John Hopkins Health Alert discusses how FDA approval can actually help to identify unsafe drugs and devices by requiring the collection of data on their effects. This article mentions the Medwatch System, which I think merits a post of its own. For now, I'll just say If you've had side effects or experienced the failure of an FDA-approved drug, device, or system, then report it!
- It seems that the question of liability in the event of harm caused by FDA-approved drugs and devices is a hot one. This article, from a doctor's point of view, is in favor of more a rigorous approval process at the FDA and less liability for doctors. Key quote: "FDA approval now immunizes medical-device manufacturers from state tort liability. As a result, plaintiffs will target physicians, hospitals, and health care systems."
- This, more recent article suggests that drug companies and device manufacturers are still liable.
Help me out! Any corrections or clarifications to what I said above, things to add, or new sources of information? Any thoughts based on this?
• Post 5: Lonie McMichael: Medical Rhetoric and Fat
• Post 4: Lonie McMichael: Love
• Post 3: Lonie McMichael: Resistance
• Post 2: Lonie McMichael: Internalization
• Post 1: Lonie McMichael: Intro & hook's ideology of domination
• BFB introduction and dissertation abstract.
Whether it be Jenny Craig’s assertion that “we change lives,” the Mayo Clinic’s claim to provide “reliable information to achieve weight loss and maintain a healthy weight,” or the Ad Council’s campaign showing disembodied fat body parts as the reason for taking “small steps to get healthy,” the American public is inundated with the message that weight loss is possible and necessary to obtain health. Fat individuals can often become temporarily thinner, leading the majority of persons, including fat individuals themselves, within the dominant U.S. culture to believe that fat people can become slim with the application of enough will power and effort.
When we look closely at this idea that fat is permanently changeable we can see that fat prejudice deviates from some other forms of oppression. hooks noted that “Exploited and oppressed groups … are usually encouraged by those in power to feel that their situation is hopeless, that they can do nothing to break the pattern of domination.” Fat individuals, on the other hand, are expected by the oppressors to change their status, to lose weight in order to gain the rights and privileges afforded other individuals. However, no effective solutions for losing weight have been found, say Gaesser and Gard. This situation leaves fat individuals in an untenable situation: they are expected to do the near impossible in order to be treated like normal human beings.
As of yet, we do not have a word for this bind in which fat individuals find themselves. I choose to call the situation a Sisyphean bind: a demand that the individual succeed at a futile task, one that must be performed over and over again, before being considered worthy to receive what others are granted automatically. The OED says we can consider a task Sisyphean when it is “endless and ineffective,” based on the story of Sisyphus and his rock. The god Zeus bound Sisyphus, because of the human’s hubris, to the eternal task of rolling a rock up a hill only to watch it roll back down again. Dieting is often a Sisyphean task. Traci Mann says that dieting usually creates more fat than it eliminates. Therefore, the concept of a Sisyphean bind is particularly applicable to intentional weight loss when considering weight cycling: the endless losing and regaining of weight – many times causing eventual weight gain. Fat individuals can often lose weight, at times through almost Herculean efforts, only to see the pounds come back, even when they maintain weight-loss behaviors, says W.C. Miller. So, by its very nature dieting is a fruitless task that demands a great deal of energy with little, and even negative, results. And yet society expects the fat individual to succeed at this futile task rather than itself change to accommodate fat individuals.
This bind is exacerbated by the medical community through rhetoric touting the expectation of weight loss. This bind that fat individuals find themselves in – a bind created when society promises acceptance and respect if they will only become “normal” – leads the fat individual internalize fat hatred, believing themselves that they should be other than they are. The overwhelming rhetoric argues that fat individuals should change to be more acceptable rather than society changing to be more accepting. On the surface, this pressure to lose weight is seeking to normalize the fat individual, but, in reality given that weight is seldom changeable, sets them apart as deviant; as the “Other.” To eliminate this bind, as a society we must eliminate the expectation of weight loss by fat individuals and, instead, embrace human diversity.
Thank you for letting me share a bit of my research results with you all. I am currently in negotiations with a publisher on the possibility of two books: one on medical rhetoric and fat and one on social justice issues surrounding fat. I hope to have the first one out within the year.
Allergan wants the FDA to approve the lap band for teens. From Allergan's 2009 Annual Report, page 7 (page 5 on Acrobat):
we were initially surprised by the weakness of the market and our sales of
obesity intervention products, particularly the LAP-BAND® Adjustable
Gastric Banding System...
In the United States, major regulatory files were submitted to the FDA in
2009: BOTOX® for chronic migraine, OZURDEX™ for a new indication
of uveitis and LAP-BAND® System for morbidly obese adolescents.
I don't even know what to say about this. Wait. Yes I do.
Teenagers, generally speaking,
• aren't done growing;
• have many, many years ahead of them to develop complications from nutritional deficiencies;
• haven't had kids yet, meaning that under-nutrition and deficiencies might affect future pregnancies
• think they're supposed to be perfect (and that "perfect" exists);
• are driven by a desperate need to fit in;
• are still learning how to think; and
• (as people have mentioned in the comments) can be pressured or even forced into surgery by parents and doctors.
And Allergan thinks it would be a good idea to tamper with their digestive systems in a way that will enforce semi-starvation and make a healthy diet difficult or impossible. "Oh," you say. "We're only talking about morbidly obese teenagers." And I ask you: are any of the points above less true of fat teenagers? No. No, they aren't.
I'd like to introduce you to Atchka, if you don't already know him. He's one of the founders of Fierce Freethinking Fatties and he's been more on top of the issue of expanded FDA approval for lap band use than we have at BFB, blogging about it on a regular basis since December, when he wrote an excellent background post detailing the dodgy way that the FDA came to approve the lap band for lower BMIs.
Now, check out this post on Allergan's plans. It notes that hearing dates are not yet set for approval of the lap band for teens. There's still time to do something about this one, folks.
Atchka is organizing opposition to expanded approval for gastric banding. He's set up a Facebook group to help keep people informed. This is a great idea. Let's back him on it.
Just for good measure, here's the homepage for the FDA advisory committees. It's the Gastroenterology and Urology Devices Panel of the Medical Devices Advisory Committee that's been making recommendations related to the lap band. The contact information for the department that oversees the committees and for the Center for Devices and Radiological Health, where the Medical Devices committees are based, are located on the pages I linked to above. If you feel inspired to write a letter or make phone calls, those would be good options. Alternatively, you could aim straight for the top.
Secretary of Health & Human Services
U.S. Department of Health & Human Services
200 Independence Avenue
S.W. - Washington, D.C. 20201
Imagine that you're thinking about getting a lap band. Where would you go to get information about the side effects and the long term prognosis? Of course, you'd ask your doctors for advice. However, GPs might not be well informed and baratric specialists might be biased. It would probably be best to go to a university library and ask a medical librarian for help finding relevant journal articles. However, I think it's fair to say that most lap band candidates would research the procedure using Google.
How do people use Google? A study found that a third of users will only click the first link that comes up, another third will click within the first five links, and almost no one checks the second page of results or beyond. Because of this, Search Engine Optimization (SEO), which attempts to place sites at the top of search results, has become an important marketing tool.
Squeegeelicious, a BFB member, tried using a few search terms that a lap band candidate might employ to search the web for information on lap band risks, side effects and long term effectiveness using Google: "lap band surgery," "lap band side effects," and ""lap band long term." Here's a summary of her forum post (accessible to BFB members) on the topic:
Search Phrase: lap band surgery
Three paid slots came up at the start of the search, all trying to sell me the surgery. The top ten results included the Allergan home page and seven marketing sites for weight loss surgeons and industry organizations. The Wikipedia entry on the lapband, which lists risks and side effects but doesn't explain them or discuss how common they are (and is probably policed by Allergen and bariatric surgeons), was in the top five. The Wikipedia entry also fails to mention how common it is for lap band recipients to regain the weight they lost. The tenth site was Lap-Band Surgery talk, apparently the largest Lap-Band forum on the web. It's a bit more of a wild card, because it allows users to post about their experiences. A positive news article on the lap band also appeared on the first page.
Search Phrase: lap band side effects
Again, there were paid results at the top. Most of the results on the first page were industry sites - either overt or not - that minimized the side effects and blamed the patients for problems resulting from the surgery. The most authoritative-sounding results in the top ten were Allergen's lap band page and the UC San Diego Center for the Treatment of Obesity, which lists risks and side effects but does not explain them or discuss the prevalence. The UCSD page follows quickly with the 'risks' of being obese. There were also a few poorly maintained forums and blogs. The risk of weight regain was seldom mentioned, and when it was, patients were blamed. Rounding out the first page of results and providing the only real dissenting voice was a 2003 BFB article. None of the hits above mentioned the effects of the surgery after six months except in the vaguest of terms.
Search Phrase: lap band long term
The first page included (again) the Wikipedia lap band article and an Allergan page that cites a three year study with 299 subjects. The Allergan article does list all reported side effects, and a few I hadn’t heard of before. A second Allergen page lists the effects that one might expect in the first weeks after implantation. Not exactly long term, but it provides a link to ‘6 months & beyond.’ Clicking on that link, it’s really just fluff about adjusting to your new thinner body and diet. Then there is a link for Google news, with 14 results. To sum it up, there were 12 positive articles, one reserved and questioning article about the FDA’s approval of the BMI lowering, and one result about banking.
A few other notes
I checked to see how far down I would have to go before finding a link to a negative review of the Lap-Band. For the ‘lap band’ search, the 19th result was an LA times article about a wrongful death suit connected to the surgery. It is decidedly anti-Lap-Band. For the search ‘lap band side effects,’ the last result on the second page is an article with stories of the suffering that people have gone through with the Lap-Band. For the search ‘lap band long term,’ there is a link to the same BFB article mentioned earlier at result 58, then a Women's E-news article that criticizes the FDA's move to lower the BMI recommendations and cites long-term European studies buried at result 74. It’s a good article, and points out the conflicts of interest of the panel that made the recommendation to the FDA.
While the majority of the sites gave accurate information on risks and side effects, most did not explain them or give information on their prevalence. When they did, they cited short term studies. When voices outside of funded sites surfaced, they were overwhelmingly positive about the surgery, and the few questioners were nearly drowned out. The one long term study that I did find was overwhelmingly positive towards Lap-Band, which made sense when I dug a little deeper and found that the first author of the study helped develop the technique and is one of its biggest proponents.
If someone uses Google to search for information on Lap-Band surgery, they will overwhelmingly be given Lap-Band positive information. It's likely that the person conducting the search will be hearing the same biased information from their doctors, from T.V. news stations, and from popular newspapers, and there's very little here that will change their minds once the initial hook is set. If by chance they do come across a dissenting voice, it will be so much in the minority that it will be easy to dismiss as ‘fringe’ information.
As Dr. Linda Bacon is fond of pointing out, "follow the money." I’ve followed the money, and it all flows back to people who have a vested interest in selling this product.
(by Squeegeelicious; edited and summarized by deeleigh. Thanks so much for doing this work and writing it up, Squeegeelicious)
Keeping in mind that Google's search results are dynamic and optimized based on personal information - they change day to day and they're different for everyone - I repeated Squeegeelicious's searches. I'm sorry to say that the information that came up for me was even more disturbing. Allergen's pages detailing the risks of the surgeries had disappeared. I had to hunt them down in order to link to them, and I couldn't find the one that talks about a 3-year study with 299 subjects. If anyone has a link to that, please share it in the comments.
Anyway, this made me wonder if Allergen is updating their pages following the FDA ruling - or more disturbingly, if they're deliberately making their pages on the risks and side effects of lap bands difficult to find. Are other people getting Allergen's pages on the risks and side effects of lap bands?
In conclusion, reasonably savvy people should be able to get to a list of lap band side effects and risks using Google. However, the risks and side effects - the meanings of the medical terms - will not be explained, and it will be difficult to find out the truth about how common they are. Information about the high rate of regain after lap band surgery is even more difficult to find.
Are there any medical professionals out there who would be willing to add details about the meaning and prevalence of lap band risks and side effects and the rate of weight regain to the Wikipedia article, and check up on it regularly to make sure the information stays put?