bariatric surgery

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Health Analyst Scans New Obesity Options From Drugs To Devices, Heads Back To Gym

Dr. Fiona Clement, an assistant professor in the Department of Community Health Science at the University of Calgary, writes in the journal JAMA Internal Medicine about her own struggle with obesity. (Courtesy)

Dr. Fiona Clement, an assistant professor in the Department of Community Health Science at the University of Calgary, writes in the journal JAMA Internal Medicine about her own struggle with obesity. (Courtesy)

This will not be welcome news for all of us who resolved to eat less and move more this year, but still secretly hoped that maybe medicine would step in. Maybe some novel treatment would reach maturity just as our willpower waned — a drug, a device, some new twist on surgery.

Sigh. The journal JAMA Internal Medicine is just out with an up-to-date analysis of options for treating obesity, accompanied by editor Fiona Clement’s vivid personal account of her own struggles with weight. The conclusion she draws from the latest data: “After much thought and brutal honesty with myself, I would not pursue any of the interventions; the risks outweigh the benefit,” she writes. “I’m off to the gym.”

I spoke with Dr. Clement, an assistant professor in the Department of Community Health Science at the University of Calgary, about her take on the data and her decision to discuss her own obesity — and even reveal her Body Mass Index — in print. “This is by far the bravest thing I’ve ever written, and perhaps ever done,” she says.

“After much thought and brutal honesty with myself, I would not pursue any of the interventions; the risks outweigh the benefit.”

– Dr. Fiona Clement

But first, a distillation of the data from lead author Dr. Dan Ollendorf, chief scientific officer at the Institute for Clinical and Economic Review in Boston. The review is actually geared for doctors, but here’s his summary for the general public:

Surgery: “The evidence is pretty consistent that these procedures do lead to significant weight loss in the short-term, up to about two years of follow-up. The challenge with the evidence available is that after two years, it’s a a bit of a black box. It’s unknown what actually happens. There’s some suggestion that in a pretty significant number of situations, patients actually regain weight. In cases where other conditions related to obesity, like diabetes, have improved or resolved as a result of surgery, that can be reversed in some individuals. And so that is the really big unknown with surgery: What are the longer term outcomes for patients?”

• New drugs: “The bottom line is that this is sort of more of the same. A number of drugs have been used — some FDA-approved and labeled for weight loss, others used off-label for weight loss. The new drugs result in relatively modest reductions in weight, really not very different from the existing medications that have been available for decades. They are very high cost and in some cases have the potential for really significant side effects. So there really is mixed evidence, and the benefit, if any, that appears to be available with the current evidence is pretty modest.”

Devices: “This is kind of a heart-wrenching situation because surgery is a major step for people. Most of the advanced surgical programs in the U.S. have been able to reduce their complication rates, but this is still a risky surgery, and there are some major complications that can occur. And given that medications have produced only modest weight reductions, there’s been a lot of interest in trying to produce something that may be less invasive than surgery but more effective than medication. Continue reading

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After Losing 322 Pounds, One Man’s Thoughts On Christie Surgery

Russ Hannagan before and after losing 322 pounds (Courtesy)

Russ Hannagan before and after losing 322 pounds. (Courtesy)

As a man who formerly weighed over 500 pounds, I’ve been thinking a lot about New Jersey Governor Chris Christie’s recent announcement that he had lap band surgery. And I’m not alone: The governor’s surgery has also been a hot topic among many of my weight-loss friends on Facebook and Twitter, and my fellow diet workshop participants in Newton.

As a “New Jersey Boy” myself (born and raised in Carteret, Exit 12 on the Turnpike), and because I still have many friends who live in the Garden State, I like to keep tabs on what’s happening there. At first my friends and I felt Mr. Christie was in a state of denial. I believe he was once quoted as saying he was the healthiest “overweight” man you’d ever meet. Many of us who attend diet workshops know this feeling. You are overweight but still feel it’s not a problem. Like an alcoholic who claims they can stop at any time.

We would love to sit down with him and talk with him about “The Good, The Bad, and The Ugly” of weight loss. I mention this because back in November of 2011 I weighed over 533 pounds. In a little over a year, I have lost 322 pounds. I now weigh 210. My goal weight is 200 pounds, so I am only 10 pounds away from reaching it. But it took a great deal of hard work to get to where I am now.

I know this sounds like every other Cinderella story out there but through the years I have tried every diet in the book. From counting calories, to getting food shipped to me, to attending overeaters classes; you name it and I have tried it. Sure, I would lose the weight for a while and I would be healthy, but then it would all come back with a vengeance and I would be even worse then I was before.

Russ Hannagan celebrates his 50th birthday, a year after his surgery. (Courtesy)

Russ Hannagan celebrates his 50th birthday, a year after his surgery. (Courtesy)

My epiphany came when I met a friend I had not seen in a long time. I literally did not recognize her because she’d lost so much weight. I asked her what she’d done to transform herself. That’s when she told me about bariatric weight-loss surgery.

There are two main types of this surgery (and I’m not counting lap band surgery here). With the bariatric procedure they surgically alter your stomach into a small pouch (Roux-en-Y) or a gastric by pass sleeve. I won’t go into all the details — but suffice it to say I got the pouch.

Each month at Newton Wellesley Hospital, I attend these free diet workshops with other patients who are having or have had the surgery. The nurses, nutritionists, doctors, and fellow patients teach each other how to eat right and exercise properly. We all continue to attend the workshops to stay current on what types of vitamins are available and how stay healthy. The surgery is a tool — not a cure and not a goal. In the right hands and used in the correct way this tool can make your life so much better. I am proof of that. Used incorrectly it can be as useless as any other fad diet out there. Continue reading

Weight-Loss Surgeon: Christie-Style Secrecy Common, Stigma Lingers

New Jersey Gov. Chris Christie is surrounded by security and journalists in 2012. (Getty Images via NPR)

New Jersey Gov. Chris Christie is surrounded by security and journalists in 2012. (Getty Images via NPR)

 

I’m not sure which is grabbier news: That New Jersey Governor Chris Christie underwent weight-loss surgery in February or that he felt compelled to keep the operation secret until The New York Post was about to publish a story about it.

I asked Dr. Daniel B. Jones, director of the Weight Loss Surgery Center at Beth Israel Deaconess Medical Center and a Harvard professor of Surgery, for his perspective. He began by emphasizing that all patients are entitled to privacy about their health care, including a governor. He went on:

That said, it is not uncommon for patients, when they have weight loss surgery, to say, ‘I don’t want anyone to know about this.’ We try to get patients over that hump as part of the pre-operative evaluation.

As physicians, we really want patients to identify: Who’s your support group? Who’s your champion? If your spouse doesn’t know what you’re doing, they’ll bring junk food into the house; if family members don’t know, they may think you’re not eating enough. So we really want some core people to know what’s going on. That said, most people do have a core group but don’t want other people to know.

Dr. Daniel B. Jones (BIDMC)

Dr. Daniel B. Jones (BIDMC)

We don’t know the reason but we think there’s still sort of a stigma to having weight-loss surgery. So even though we’re doing 150,000 weight-loss operations a year [in the United States], there’s the idea that if you have a weight-loss operation you’re somehow ‘taking the easy way out.’ You’re kind of ‘cheating.’ You’re just not tough enough to do the diet and exercise required for weight loss. You’re somehow ‘weak,’ right?

We even see this with gastric bypass patients who, six months after surgery, when they’ve lost 100 pounds and they’re healthier and more mobile, they still ask themselves, ‘Should I have done this without an operation?’

So this is sort of normal. In fact, I had a nurse — this was a real clandestine operation. She came in with a separate name, only a bare-minimum number of people got to know who it was. It was done in complete secrecy, but three to four months later, after her lap band was working, the whole hospital knew she’d had it. So what happens is, you reach a point of ‘Everyone can know.’

I quote people a 40-percent chance that the band over their lifetime will need to be repaired, revised or removed.

The other part of it is a concern that you might fail. And the pressure’s kind of high. So once you’re winning, everyone likes to share success. Not everyone knows whether they’re going to achieve it. You have to remember, everyone who’s had a weight loss operation has, by definition, already been on multiple diets — that’s a requirement for any operation in an accredited bariatric program. It’s very common for people to have lost 15 or 50 or 100 pounds, and for one reason or another they’ve gained back even more. It has to do with our physiology. It’s not about willpower.

The body has a set point and whether you like it nor not, your body hovers there. So if you diet in the traditional sense and knock the weight down, your body thinks you’re somehow starving it. And the first chance it gets, it fires off chemicals that not only push you back to where you started, it sets your new set point higher. We call this yo-yo-ing.

Whether it’s the band or the sleeve or the bypass, [weight-loss operations] do things that make it possible for people to get the weight off and keep it off. Continue reading