they added “to your P&L” to it
Tell me about it. What bugs me is that it’s such a vulnerable population because they’re not in a particularly good position to do research and self-advocate. The man in the white coat tells you it’s a good idea, and the next thing you know you’re counting backwards from 10.
The odds playing Russian roulette are 16.7%. The odds for a bariatric surgery after the age of 65 are 3.1%. I don’t think they give these folks a brochure that says, “The risks are low. Your survival odds are 5 times better than Russian roulette!” but they should. If you literally get to decide what your patients are eating, it just seems like there has to be a better way.
They know CICO doesn’t work just from this group. They control the food yet the patients don’t lose weight.
I use to work in the world of Bariatric Surgery as a coordinator at my hospital. One of my job requirements was to collect follow-up patient information (who had their surgeries performed at our hospital) from the surgeons office from the doctor’s office to data input (for future audits).
I was so shocked by how many patients were lost to follow-up, sometimes as soon as the surgery was done! And others who did develop complications would get admitted to another hospital so it would be harder for me to collect their medical information (Our surgeons had pilverges at all the surrounding hospital, so I suspect they purposely told patients where to go for emergencies).
I don’t do that work anymore and I never will again. I commend the State of Pennsylvania for keeping tabs on this and sharing this information, I hope other states are doing the same because the lack of longterm safety of bariatric surgeries is shocking.
Eating no more than three meals a day and finishing eating well before bedtime—what a concept!
This is intriguing and very sad. However I work with two colleagues that have had bariatric surgery in the last 5 years and we’re all on Kaiser. Kaiser has no incentive to perform expensive and dangerous surgery when there is a much safer, free alternative in the keto woe and/or fasting. I think you are underestimating the level of ignorance and cognitive dissonance that pervades the medical community when it comes to obesity. All they know is to tell patients to eat less/move more, and when that fails, as it always fails, out comes the scalpel…
I think you’re right about that. I think most people go into the field of medicine are really good people, who genuinely care and want to help. That’s seems true of the medical professionals I know at least. But…
The first thing I learned as a bright eyed management consultant was that when something doesn’t make sense, and it’s costing the corporation a fortune, always ask a simple question: “cui bono?”. When you start thinking about the problem in terms of who benefits, things often start to make more sense. It doesn’t mean you have any chance of solving the problem, but at least you know where the pain points are, and which buttons to leave untouched to avoid institutional resistance.
To your point though, the second thing I learned was, "“Never attribute to malice that which is adequately explained by stupidity.” (Hanlon’s Razor)
How do you know which best explains the problem? Well, if nobody really benefits, it’s probably just stupidity. On the other hand if the people responsible for perpetuating the existing system are driving Porsche’s, and live in $1,000,000 dollar houses, the cui bono principle applies, and you know who has a vested interest in keeping the system broken. These guys drive Porsche’s. They’re also the guys who do the patient consults, and who make the recommendations.
The insurance plan executives get paid the same regardless. If a board certified bariatrician declares it medically necessary, that there is no alternative, and that not doing it will cost more in long term obesity related medical complications, insurance will approve it.
There is an alternative. My gut instinct is that many of the folks making $400k+, who do the patient consults, and who are the ones who make the recommendations, are going to continue to have the opinion that there is no alternative. I don’t think it’s some kind of grand conspiracy or anything, I think it’s just human nature.
You’re so right. It’s all about using the right words with doctors. My neurologist is always on me about what I should do to lose weight, etc. So, when I had my most recent appointment and he was delighted in my weight loss since he’s seen me 6 months ago, I didn’t mention fasting or KETO. I said, “I’ve been avoiding bread and sugar.” And he said, “That’ll do it!”
I’m not trying to support WLS, but this type of “study” irritates me. You can’t accurately compare number of deaths in the first 30 days to the number of natural deaths unless you FIRST control for everything else.
As in, yes, you can compare the number of deaths between 2 populations if those populations are the SAME. As in, compare a group of 500 people who each weigh more than 600 lbs, each have diabetes, hypertension, live the same sedentary live, etc. If you don’t control for those other factors, then you really can’t blame the increased mortality rate on WLS.
Age- and sex-specific death rates after bariatric surgery were substantially higher than comparable rates for the age- and sex-matched Pennsylvania population.
Of course they would be. Death rates are higher for obese patients even without WLS. If all they did was control for age and sex, then the WLS really might have NOTHING to do with it.
The 1-year case fatality rate was approximately 1% and nearly 6% at 5 years.
Again, that would be expected with obesity. What they should do is compare the death rates of obese people with and without the surgery. You can’t compare obesity-related death rates to the death rates of the general population and then blame the difference on WLS.
Less than 1% of deaths occurred within the first 30 days.
So not necessarily directly due to WLS, but could very well simply be complications due to the obesity.
Fatality increased substantially with age (especially among those > 65 years)
Again, how is this due to WLS? People are more likely to die as they age.
I had WLS. I don’t regret it but I also wouldn’t recommend it to anyone either. But at the time, I didn’t know about keto. WLS proved to me that I really could lose weight and, in fact, post-WLS, my diet was probably very close to a ketogenic one. As much as I’d like to say that everyone can “do” keto, I think some really can’t. Their hunger is too great, they need more direct negative biofeedback when they over-eat, they need the initial success that WLS often brings, etc.
So if it’s a choice between continued obesity and WLS, WLS isn’t the bad guy. And if someone is going to do a “study” to say WLS patients are at higher risk of death, then they need to make sure it’s due to the WLS and NOT obesity. This is the whole “drowning deaths increase when ice cream consumption increases.”
“It is difficult to get a man to understand something, when his salary depends on his not understanding it.”—Upton Sinclair
This is a really good point and I totally agree with you. I said as much above (reposted below). I’d love to see a study that compares apples to apples. The data is impossible to interpret accurately otherwise.
Still though, inferences can be made. When the leading cause of death is “therapeutic complications” to the surgery itself, it’s reasonable to infer that people who did not receive surgery did not die of surgical complications.
Sussing out the particulars with regards to the death risk from things like sepsis, GI bleeding, pneumonia, and pulmonary embolism, definitely require a high quality control group and sufficient statistical power to have a tight confidence interval.
I don’t think WLS is bad per se. I think it probably saves far more lives than it ends. Morbid obesity is a killer. What concerns me is that there are alternatives to WLS but there are strong financial incentives that favor WLS, and that the people making the recommendations have a great deal of money to make if a surgery is performed, and they only get pennies if it’s resolved through diet.
When I sat down for a consult with a practicing, board certified bariatrician, who is also a professor of bariatric surgery incidentally, she looked me in the eye and told me that keto was dangerous, that fasting was even more dangerous, and that a high carb low fat diet DASH diet was my best option for successful weight loss. She makes more a month than most people make a year selling this dietary advice and the surgery that follows it’s inevitable failure. She’s teaching her medical students this. Why? Cui bono?
But the inference would apply to any surgery while being obese, not specifically WLS. It’s pretty much a given that mortality rates during surgery (and recovery) increase when a patient is also obese. Everything about the surgery is more difficult, from the surgery itself, to post-op care, etc. So it’s irritating that the study implies that the causation is WLsurgery, when it’s not.
I don’t know if they accounted for this in the study, my mom had lapband and lost a ton of weight, all of her weight-related health problems went away. Then she found out at her new weight, she was no longer considered “disabled” and was expected to get a job and lose her disability.
She told her doctor to loosen the band and she ate herself back into “disability” adding about 70lbs more than where are started… all because she didn’t want to work and support herself.
I also know a woman about my age, maybe a little younger, who had bariatric surgery. She went from 300 to 130lbs. She looked fabulous. But she used to lament about the damage it did to her and she said she wished she’d never done it.
What kept me away from surgery was the story of one woman who died during the surgery. She left behind a 4 year old son and the grandparents were just beside themselves because they didn’t think she really needed to lose weight in the first place. She did it because she felt like a bad mom being overweight.
Watching this whole discussion (and others), one thing I just want to scream: Can we stop saying morbidly obese and obese, in general? Can we just go back to being fat or overweight, please? Why do we allow doctors to label us with such demeaning things? The chart is crazy where one becomes morbidly obese according to modern medicine. One minute we’re a little overweight and 5 lbs later we’re grotesque creatures who disgust the hypocrites who diagnose and label us.
Another thing that irks me is the assumption that we’ve all done nothing but stuff our faces for decades…like nothing else contributes to weight gain. I consider my status to be medically fat…as in my doctors did this to me and refuse to accept responsibility for it.
Okay. Sorry. Rant over. LOL
I had bariatric surgery and loved it. I’m 5 foot 8 and got up to 285 pounds. After surgery I got down to 170 pounds. It works great. And I was self pay and it only cost me $8,000. Some insurances pay for all of it. After a few years I gained some back but I was shoveling chocolate in my mouth with gusto. Now days I’m keto plus IF 18:6 five days a week but my stomach is still very small (because of the surgery) and I can’t over eat. Anyway, I don’t regret surgery at all.
Why? They’re just objective terms that describe a thing. Your reaction is dictated by you, not them.
I’m not sure why you’re okay with “fat”, but have issues with the medical terms that describe your level of fatness. would you rather they say double fat, triple fat and “hey,hey,hey.” For me one of my favorite things to hear the Dr. say is “you’re no longer.” I was morbidly obese, then extremely obese, now I’m just obese, next step “overweight.” I think the medical terms are much easier on my ego than the crap some people say. Several years ago when a new operator was sent to ask me for something and they didn’t know who i was they were told to just look for the “old fat guy.” (I had HR talk to that one.) Yes, I am still “fat,” but enough less now that I’m “the heavy set mature man.” I would never tolerate being openly called “fat” again by anyone. The Dr.s can use whatever term is correct whenever it is preceded by “you’re no longer.” Just a bit more perspective: the Dr. telling me i was no longer morbidly obese, was even more relieving than when I was told my cancer was in complete remission.
So, it would have been better if they had referred to you as the “old morbidly obese man”?
If you want to own morbid obesity, knock yourself out.
In some cultures being fat isn’t shameful. It shouldn’t have to be anywhere. I understand how some people might prefer being called fat. “Obese” has become something of a death sentence. Being fat just means having an extra emergency storage of energy. A fat pig is tasty, an obese pig sounds too sick to be considered food.
This doesn’t mean that it’s right to call each other fat, the way things are right now. But neither is obese ok to use for anyone other than your doctor. And there is a certain limitation to the euphemisms too.
Everything will be easier when I can’t be considered fat in the slightest. My daughter never called me fat in disgust, though, she always said she loved the softness. She probably wouldn’t even want me to go keto if not for all the health benefits.
At least one person understands what I was saying. Thank you.
I certainly wasn’t advocating for name calling either.