Here’s one of the studies I’d saved and forgotten until I got organized over the holidays.  The researchers took a survey among doctors to determine their attitudes towards the obese.  Let’s look at the results:

Six hundred twenty physicians responded. They rated physical inactivity as significantly more important than any other cause of obesity. Two other behavioral factors — overeating and a high-fat diet — received the next highest mean ratings. More than 50% of physicians viewed obese patients as awkward, unattractive, ugly, and noncompliant.

So there’s the consensus medical opinion for you:  obese people are obese because they don’t move around enough and eat too much fat.  If you need more evidence that the average doctor doesn’t don’t know diddly about weight loss, there it is.

In his book Fat Politics, Professor Eric Oliver (who appeared in Fat Head) wrote that obese people often avoid doctors – thus allowing treatable conditions to go untreated – because they’re afraid they’ll be criticized for their size.  Given the results of this survey, I’d say that’s a reasonable fear.

“Why aren’t you sticking to the low-fat diet and exercise program I prescribed?!”

“I am, Doctor.”

“No, you’re clearly not.  Just look at you.  You’re awkward, unattractive, ugly and noncompliant.  Now, when should we schedule you for a follow-up visit?”

Unfortunately, much if not most of the general public shares the same belief:  obesity is the result of laziness.  I was reminded of that in two emails I received this week from readers.  Here’s part of the first one:

Having watched Super Size Me I was, as I assume many others were, led to believe what the film intended: the vast majority of Americans are fat, lazy and (for lack of a better term) stupid — a belief I’ve pretty much held my entire life. Being athletic and “skinny,” I have done nothing but look down on those who didn’t match what I saw in the mirror.

I thought all you had to do to be like me is get your ass off the couch and do something. Burn more calories, lose weight, easy enough … or so I thought.  Having grown older and somewhat wiser, I’ve started realizing the faults of that mentality.

Put an M.D. after his name and take away the wisdom that came with maturity, and you’d have your average doctor looking at an obese patient.  Thank goodness he saw the light (and Fat Head.)

Here’s another email from a guy who also believed losing weight was all about being more active – until he gained weight himself:

I was always skinny as a child. I wrestled in high school at a lower weight (130), at 5’9″. The coach was a popular guy, so we often got graduates coming back to practice with the team a few times on their college winter break. Invariably, the graduates would be well over their old weights, leading to joking around about how “fat” they’d become. The coach would always tell us that, in time, we’d all develop paunches and be “fat old men.” We just accepted it, while we downed rice cakes and diet cola at lunch during the season to keep us in our weight class –by senior year, this was already difficult for me, despite the grueling practices.

Years passed (I’ve always wanted to write that)….

When I hit 30, I looked at my weight. Despite never being “fat”, I’d gone up to 170-175lbs (depending on whether I’d pigged out or not the last few days), which is overweight on the BMI scale.

I immediately started working out again like I did on the old squad, and pretty soon had a 2-3 times per week routine of distance running and weight training. I clocked a 7 minute mile in 6 months, and was lifting a substantial amount. Yet, despite all this hard work, I was still tipping the scales at 170lbs!

My diet was “extra healthy”: a glass of orange juice for breakfast, with perhaps some oatmeal; a meal of rice, beans, and cheese for lunch (easy on that fatty cheese, pile on the rice and beans!); and spaghetti for dinner, with 2-3 pieces of wheat bread to mop up the sauce. For a snack, an English muffin, or else three “reduced fat” Oreos. Yet, after months of this “healthy eating,” I still was at 170lbs on my best day! Who’d have thunk it, right?

And then the injuries started up. Plantar fascitis was a huge one—I’d wake up in the morning and feel a ton of pain just standing up. The podiatrist I saw gave me some painkillers and told me I’d need some inserts for my shoes, probably for most of my life. My back and neck ached too.

At first I just thought I was getting old. So I continued to work out. I hit 10 pullups, 100 situps, and 50 pushups, with my running at a 7 minute mile clip and lifting weights. But … more pain, no weight loss!

The reader saw Fat Head and decided to try a low-carb diet based on meats, eggs and vegetables with some full-dairy.  He hoped to lose 3-4 pounds in the first month.  He lost 10 instead.  He continues:

I nearly flipped out! As one person wrote on another website, low-carb dieting was like playing a video game with a God-mode-cheat-code. So easy! I didn’t count calories, never skimped on a meal, was always full and happy. And I hadn’t seen 160 since…well, I don’t know when I passed it to begin with, but certainly not since I passed 30.

Full, happy, no counting calories … that’s my life now.  I didn’t make a New Year’s resolution to lose weight this year and haven’t in three years. I don’t even own a scale.  My only diet resolution this year was to return to what I know works after indulging a bit over the holidays.

The “fluffy” picture (as one reader kindly put it) I posted earlier in the week was of me on a low-fat diet – and I was a regular jogger in those days.  (I once found a videotape of me jogging, looking quite fat in my jogging outfit.)  I also worked out at a Nautilus club two or three times per week.  An athletic, naturally-lean buddy of mine (who also believed people are fat because they eat too much and don’t move around enough) once joined me for a workout and admitted later he was surprised by how much I could out-lift him.

Despite the low-fat diet and all that physical effort (doctor approved!), I was fat.  I wasn’t morbidly obese, but I do remember a doctor pointedly telling me I should focus on losing some weight.  He likely thought I was lazy and sat around all the time.  Hardly.  I probably could have beaten him in either an arm-wrestling match or a 5k race.

It’s January, so millions of fat Americans are hitting the gyms and health clubs, hoping to sweat their way into leaner physiques.  Their doctors would approve.

Around April or so, many of them will become frustrated and give up — at least that’s the annual pattern Chareva and I have noticed at the rec center where we work out.  Their doctors will disapprove, labeling them as lazy and non-compliant.

Their doctors don’t know squat.

The Older Brother wrote a good post on his blog about the failure of drugs that remove amyloid plaques in the brain to actually prevent or reverse Alzheimer’s.  Those plaques, like cholesterol in coronary arteries, may be a defense against damage, not the cause of the damage itself.

You can read his post here.

I’ve mentioned before that when doctors or nurses ask me what prescription drugs I’m taking and I answer “none,” they seem surprised.  A couple of you made the same observation in comments.  That got me wondering what percent of people, say, over the age of 50 are taking some kind of prescription medication on a regular basis.

It took a little more digging than I expected to find an answer.  The first source that popped up in my Google search was a CDC report on what percent of Americans have taken at least one prescription drug in the past 30 days.  The answer was nearly half, but that’s a useless bit of data for answering my question.  I’m taking a prescription drug right now to treat an infection, but I don’t take one on a regular basis.

The same CDC report also suffered from useless statistical groupings.  For example, it grouped the population by age like this:

0-11
12-19
20-59
60 and over

Going from the 20-59 group to the 60 and over group, prescription drug use in the past 30 days jumped from 48% to 88%.  Wow … we must really fall apart after we turn 60, right?

No, of course not.  Lumping 57-year-olds together with 22-year-olds is ridiculous when it comes to reporting on prescription drug use.  The people I know who take prescription drugs on a regular basis started doing so sometime after age 40.

I finally found relevant data about regular drug use in US News article and in a report published by the AARP.  It isn’t a pretty picture.  As US News reported:

Today, a full 61 percent of adults use at least one drug to treat a chronic health problem, a nearly 15 percent rise since 2001.  More than 1 in 4 seniors gulp down at least five medications daily.

An adult, of course, is anyone over the age of 18.  That doesn’t narrow it down much.  AARP had better figures for people in my age bracket, i.e., adults over the age of 50:

The vast majority of Americans age 50+ (85%) say they have taken a prescription drug in the past five years, and three-fourths (76%) say they are currently taking at least one prescription drug on a regular basis.

So yes, those of who make it past age 50 without taking at least one prescription drug on a regular basis are in the minority, if not exactly unusual.  That’s sad.  The figures are even more depressing for the over-65 group:

Americans age 65+ (87%) are even more likely to say they take a prescription drug on a regular basis than those between the ages of 50-64 years (67%).

Yee-ikes.  Gather up a group of 10 retirees, and the odds are that nine of them are taking some kind of drug every day.  I plan to the one who doesn’t.

Those who say they are currently taking prescription drugs regularly say they take on average four different prescriptions drugs daily.

Scratch what I said above.  Gather up a group of 10 retirees, and the odds are the most of them are taking several drugs every day.

Overmedicating is a particular problem for seniors, more than half of whom take three or more medications per day. “The drug-drug interactions can be worse than the disease,” says John Morley, director of geriatric medicine at the St. Louis VA Medical Center. And too often, he adds, “doctors seem to suspend common sense” when devising a treatment plan. For example, they prescribe Aricept for Alzheimer’s patients and then treat a frequent side effect, urinary incontinence, with an anticholinergic like Enablex or Ditropan whose side effects include delirium, confusion, and memory loss. A current concern among public health experts is the use of antipsychotics in nursing homes to treat anxiety, confusion, and irritability, all frequently triggered by other medications.

Yup, people are taking drugs to treat the side effects of taking drugs.  Here’s one the US News article didn’t mention:  nearly 45% of Americans over the age of 60 are on a statin.  How many of those people are also on a painkiller to treat muscle and joint pain that their doctors haven’t traced to the statin?  I don’t have data on that, but my guess is that it’s rather a lot.

You could make a credible argument that statins are beneficial for one particular group of people:  men under the age of 65 who already have heart disease.  (And then I’d argue in reply that most of those men could achieve greater benefits with a change in diet.)  But there’s no way on God’s Green Earth that 45% of the people over age 60 are benefiting from beating down their cholesterol.  Most are wasting money at best, and paying to suffer needless side effects at worst.

Many medications serve an important purpose, as I was reminded this week.  If you’ve got a bacterial infection, an antibiotic is a blessing.  Some people will require drugs to control high blood pressure, high glucose, pain, seizures, etc.  no matter which diet they adopt.

But when nearly nine out of 10 seniors are taking prescription drugs, that’s not a blessing.  That’s a medical system treating lipid panels instead of heart disease.  That’s a medical system largely treating the effects of sugars, grains and processed seed oils in our diets — not the natural effects of living for more than 65 years.

As if we didn’t already know …

A newly-published study highlights one of the nasty side-effects of statins:

The popular cholesterol-lowering drugs known as statins might take a toll on people’s energy levels, a new study suggests.

Researchers say the potential side effect, which has yet to be confirmed by other experiments, is a particular concern for women. They estimate that out of 10 women taking Merck’s Zocor, also called simvastatin, four would have less energy or feel more tired during exercise due to the drug.

Well, that’s the thing:  when a drug destroys the mitochondria in your muscles, you tend to feel a bit fatigued while exercising.  Doing the same work with a weaker muscle means the muscle will wear out sooner.

As I wrote in a post last year, athletes are particularly quick to notice the loss of strength caused by statins and to stop taking them.  No surprise there, since for a professional athlete, a small change in athletic performance can mean the difference between being a millionaire or a has-been.  For people whose most strenuous activity is walking from the parking lot to the office doors, the damage could go undetected for a long time.

Dr. Beatrice Golomb, who led the new research, told Reuters Health that many patients experience fatigue after starting on a statin, but that the evidence until now has been limited to observations.

We’ve met Dr. Golomb before.  She’s been tracking the effects of statins for years and gave an outstanding (if a bit hard to follow because she speaks so quickly) lecture on how pharmaceutical companies have corrupted medical science that I embedded in a previous post.

Statins are generally thought to be safe drugs, but may cause muscle and joint pain in some patients.

Statins are generally thought to be safe because doctors are generally misinformed about the side effects and don’t generally spot and report them.  As I’ve mentioned before, my mom suffered muscle and joint pain on statins.  Her doctor never made the connection and (of course) prescribed pain pills to cover the effects.

Dr. Franz Messerli, who runs the hypertension program at St. Luke’s-Roosevelt Hospital in New York and was not involved in the research, said the new findings were concerning and not unexpected given statins’ effect on muscle tissue.

But another expert cautioned that the study had some limitations and said patients shouldn’t stop taking their medication before talking to a doctor.

Gosh yes, talk to your generally misinformed doctor before dumping a medication you don’t need in the first place.  That way your doctor can say, “But it makes me feel good about myself when your cholesterol score goes down, so I’d urge you to keep taking the drugs.”

“Fatigue is reversible and not fatal,” Dr. Kausik Ray told Reuters Health by email. “Risks and benefits in absolute terms should be discussed on a case by case basis.”

What the @#$% makes Dr. Ray so sure the fatigue is reversible?  According to Dr. Duane Graveline, who has been studying statin side-effects for years, the damage to the mitochondria can be permanent — as it was in his case.

And are we really going to tell people it’s okay to be fatigued for the rest of their lives as long as the effect isn’t fatal?!

“I have good news and bad news, Ms. Smith.”

“What’s the bad news, Doctor?”

“You’ll probably feel tired and sore for the rest of your life.”

“What’s the good news?”

“You can live a long, long time feeling tired and sore.”

Ray, who studies heart disease prevention at St. George’s University of London, added that in his experience fatigue is not a common problem with statins.

My mom’s doctor would probably make the same statement, since she didn’t connect the muscle pain and fatigue to the statins.

But Golomb, of the University of California, San Diego, countered that doctors often fail to make the link between fatigue and statin use in their patients.  “Often it doesn’t show up right away so physicians may not recognize the effect,” she told Reuters Health.

Like I said …

Neither Merck nor Bristol-Myers Squibb could provide comments on the findings, which are published in Archives of Internal Medicine.

Don’t be silly.  Of course they could provide comment.  They chose not to, for obvious reasons.

Studies have found that in people without heart disease the benefits of statins are very small at best. As a result, Golomb said, it’s worth considering potential side effects such as fatigue before taking the drugs.

Yes, pretty please, consider the potential side-effects:  muscle damage, joint pain, cognitive impairment, diabetes, liver damage, and loss of sex drive, to name just a few.

Then tell your doctor no, you won’t be taking statins.

Just when I think the medical profession can’t sink any lower, it digs a trench a climbs in.

My previous post was about a new study claiming that surgery reverses diabetes more effectively than diet and drugs – the only problem, of course, was that the diet was the American Diabetes Association’s high-carbohydrate diet.  The study was set up to produce a better outcome for surgery.  That’s sinking pretty low.

Now here’s the new low:  Researchers are giving a diabetes drug to pregnant women, essentially drugging their unborn babies, in an attempt to prevent the babies from becoming obese.  Here are some quotes from an article in the U.K. Daily Mail:

In a world first, dangerously overweight mothers-to-be in four British cities have started taking a diabetes drug during their pregnancy. The doctors behind the controversial NHS trial say that obesity among pregnant women is reaching epidemic proportions and they need to act now to protect the health of tomorrow’s children.

Yes, they do need to act now.  They could start by telling pregnant women that the Eat Well Plate (the UK’s version of our USDA Food Plate) is a crock of @#$%.  Here’s what the official Eat Well site recommends:

• Plenty of fruit and vegetables
• Plenty of potatoes, bread, rice, pasta and other starchy foods
• Some milk and dairy foods
• Some meat, fish, eggs, beans and other non-dairy sources of protein
• Just a small amount of foods and drinks high in fat and/or sugar

So you’re an obese, insulin-resistant British mom-to-be, and you follow the Eat Well guidelines by eating plenty of fruit, plenty of starchy foods, and just a bit of meat and dairy.  Great.  You just sent your blood sugar through the roof.

I swear, every time I see these government goofballs put fat and sugar into the same category, I want to kidnap two of them, stuff a pound of sugar down one’s throat and a pound of lard down the other’s, then have them compare notes on the effects.  They might notice a slight difference.

However, there is likely to be unease about resorting to medication in pregnancy for a problem that can be treated through changes in diet and exercise.

Yes, this problem can be treated through changes in diet.  But not if the diet consists of plenty of fruit and plenty of potatoes, bread, rice, pasta and other starchy foods.

If the strategy is a success, the treatment could be in widespread use in as little as five years, with tens of thousands of overweight but otherwise healthy mothers-to-be drugged each year.

This will be a boon not just for the pharmaceutical industry, but for the paper industry as well.  Doctors will be going through prescription pads like crazy.

The Daily Mail recently revealed the rise of the ‘sumo baby’, with the number of newborns weighing more than 11lb soaring by 50 per cent over the last four years.

Remember the days when a big baby was considered a healthy baby?  Not anymore.  Now more and more babies are big because they’ve already been biochemically programmed to become obese.

The trial involves 400 pregnant women in Liverpool, Coventry, Sheffield and Edinburgh. They have started taking metformin, which has been safely used by diabetics for decades and is cleared for the treatment of diabetes in pregnancy. It costs just pence per tablet.

Okay, maybe not a huge boon to the pharmaceutical industry.  But tens of thousands of prescriptions will still add up to a tidy profit.

The study aims to exploit the ability of metformin to lower levels of the hormone insulin in the bloodstream. Obese women make more insulin than other mothers-to-be and this leads to a greater nutrition supply reaching the baby. It is hoped that lowering levels of insulin will reduce the supply and so cut the odds of babies being born obese.

What, they’re blaming high levels of insulin?  No, no, no .. insulin has nothing to do with becoming obese.  Just ask all those people who are calling Gary Taubes an idiot on their blogs.  The problem here is food reward.  The moms are eating too much palatable food, so their babies are sitting there in the womb thinking, “Dang, that’s good stuff!  Salty, sweet, fatty … delicious!  I’m going to open the spigot on my feeding tube and have another couple of servings!”

Study leader Professor Jane Norman of Edinburgh University said: ‘One of the challenges is that many women feel perfectly healthy but there is very good evidence that women who are obese have an increased risk of pregnancy problems and their babies are at risk, and we’d like to reduce that risk.’

Addressing concerns about unborn babies being medicated for a problem that many would say could be treated by diet and exercise, she said: ‘I absolutely support the improvement of diet and encouraging exercise. ‘But we are increasingly faced with women who start their pregnancy obese. Saying at that stage to eat less and exercise more is not particularly helpful.’

No, we shouldn’t be telling pregnant women to eat less.  We should be telling them to eat differently.  We should be telling them to adopt a diet that doesn’t pump their unborn babies full of insulin.  Giving pregnant women a drug to beat down their glucose and insulin levels when switching to a low-carb, high-fat diet will accomplish the same goal is just nuts.

p.s. — I apologize for going all day without checking comments.  I was juggling projects and just now got around to it.

One of the times I interviewed Dr. Mike Eades for Fat Head, he told me (after we were done shooting) that the usual treatment pattern for type 2 diabetes and other diet-related ailments goes something like this:

• Doctor puts patient on a low-fat diet
• Patient’s condition doesn’t get any better or gets even worse
• Doctor declares that diet won’t fix the problem and prescribes a drug

I’m afraid we’ll soon be seeing more and more of an alternate version of that treatment pattern:

• Doctor puts patient on a low-fat diet
• Patient’s condition doesn’t get any better or gets even worse
• Doctor declares that diet won’t fix the problem and recommends surgery

There were some dramatic headlines this week about a new study showing that weight-loss surgery works even better than diet or drugs (wow!) for reversing type 2 diabetes. Here are some quotes from a news story in the New York Times:

Two studies have found that weight-loss operations worked much better than the standard therapies for Type 2 diabetes in obese and overweight people whose blood sugar was out of control. Those who had surgery, which stapled the stomach and rerouted the small intestine, were much more likely to have a complete remission of diabetes, or to need less medicine, than people who were given the typical regimen of drugs, diet and exercise.

Hmm, I wonder what the typical regimen of drugs, diet and exercise would be? We’ll come back to that.

The new studies, published on Monday by The New England Journal of Medicine, are the first to rigorously compare medical treatment with these particular stomach and intestinal operations as ways to control diabetes. Doctors had been noticing for years that weight-loss operations, also called bariatric surgery, could sometimes get rid of Type 2 diabetes. But they had no hard data.

Experts say better treatments are desperately needed for the disease.

“Type 2 diabetes is one of the fastest growing epidemics in human history,” according to an editorial published with the two studies.

Yes indeed, rates of type 2 diabetes have been skyrocketing in the past few decades. Now … what’s changed in the population since, say, 1980? Have we been suffering from a shortage of bariatric surgery, whereas our grandparents all had their stomachs stapled as part of their high-school graduation ceremonies? I don’t think so.

One of the studies, conducted at the Catholic University in Rome, compared two types of surgery with usual medical treatment. After two years, the surgical groups had complete remission rates of 75 percent and 95 percent; there were no remissions in patients who received medical treatment.

The second study, at the Cleveland Clinic, compared two types of surgery with an intensive medical regimen. The remission rates one year after surgery were lower than in the Italian study — 42 percent and 37 percent — at least in part because the American study used a stricter definition of remission.

Sounds as if those Italians need to tighten up their definitions a bit. Otherwise we’ll have diabetics moving to Italy so they can become non-diabetics. The Italian Tourism Board may even start a new campaign.

Come to Italy! The scenery is a-lovely, the people are a-nice, and your fasting glucose will-a drop by 30 points!

I looked up the study conducted in the U.S. to see what “typical” regimen produced such lousy results compared to hacking up the digestive system. Can’t say I was surprised:

All patients received intensive medical therapy, as defined by American Diabetes Association (ADA) guidelines, including lifestyle counseling, weight management, frequent home glucose monitoring, and the use of newer drug therapies (e.g., incretin analogues) approved by the Food and Drug Administration.

Fabulous. The non-surgical patients were told to follow the ADA guidelines … you know, the guidelines that explain how carbohydrates drive up your blood sugar and therefore you should base your diet on them. Talk about rigging the game in your favor. That’s like spiking one team’s Gatorade with vodka before the Super Bowl.

Tom Brady is having a rough day out there. He’s been sacked six times, he’s been knocked down three times, and he’s fallen down 22 times for no apparent reason. I guess the Giants are just a better team, folks.

Every 3 months for the first 12 months, patients returned for study visits with a diabetes specialist at the Cleveland Clinic. Patients were counseled by a diabetes educator and evaluated for bariatric surgery by a psychologist and encouraged to participate in the Weight Watchers program.

Double fabulous. The patients were counseled by a diabetes educator. Here’s all you need to know about that: Hope Warshaw is a diabetes educator.

Then they were encouraged to follow the Weight Watchers diet – another low-fat diet. The researchers not only spiked the opposing team’s Gatorade with vodka, they added a few sleeping pills as well.

Folks, Brady just went down again despite not being touched, and I don’t think he’s getting up. This Giants defense is on fire today!

So we had one group of patients who were encouraged to follow a low-fat, high-carb diet and another group of patients who underwent surgery and – surprise! – the surgery group had higher rates of remission. Boy, mangling the digestive system Mother Nature gave us must perform some biological miracles.

It’s been nearly three years since I wrote about gastric bypass and lap-band surgery, so here’s a review of what patients are told to eat afterwards:

The second phase of the Lap-Band diet consists of 5 to 6 weeks of a modified full liquid diet; the key component of this phase is consuming two ounces of a protein shake every hour for ten to twelve hours a day with two ounces of other liquids such as soup, baby food, or sugar-free gelatin three times a day.

During the second six weeks following Lap-Band surgery patients may eat food that is shredded in a food processor prior to eating. The basic foods on the Lap-Band diet include meats or other forms of protein, vegetables, and salads.

After Lap-Band surgery the stomach will never hold more than 4 to 6 ounces per meal, so making every bite count is essential for healthy and nutritionally rounded weight loss success. Protein is especially important following Lap-Band surgery. The Lap-Band diet does not include most bread, potatoes and other starchy vegetables.

Surgeons reduce your stomach to an itty-bitty pouch, so you’re encouraged to base your itty-bitty meals on protein foods and vegetables while skipping the bread, potatoes and other starchy vegetables. In other words, it’s a low-carb diet … the itty-bitty version. Even if you ignored the advice and wanted to eat a big bowl of Kellogg’s Krave, you couldn’t. The itty-bitty pouch wouldn’t hold more than few ounces.

So we’re supposed to be impressed that people who undergo surgery and are limited afterwards to a few ounces of protein and vegetables end up reversing diabetes? Based on this rigged result, we’re perhaps going to start treating more diabetics with surgery – without first comparing surgery to a simple low-carb diet? What kind of doctors would promote that idea? Perhaps we should look at the disclosures in this (ahem) study:

Dr. Schauer reports receiving payment for board membership from Ethicon Endo-Surgery, Surgiquest, Barosense, RemedyMD, and Stryker, consulting fees from Ethicon Endo-Surgery, Stryker, Gore, and Carefusion, payment for expert testimony from Physicians Review of Surgery, and lecture fees from Ethicon Endo-Surgery, Allergan, Cinemed, and Quadrant Healthcare, holding a patent for a medical device to enhance weight loss in codevelopment with the Cleveland Clinic, royalties from Springer, having an equity interest in Intuitive Surgical, Barosense, Surgiquest, and RemedyMD, and receiving institutional grant support (to the Cleveland Clinic) from Ethicon Endo-Surgery and Bard Davol; Dr. Kashyap, receiving consulting fees from Ethicon; Dr. Brethauer, receiving consulting fees, lecture fees, and payment for board membership from Ethicon Endo-Surgery and lecture fees from Covidien; Dr. Kirwan, receiving grant support from Nestle and ScottCare.

Ah, I see. The study was conducted by a bunch of doctors who are paid by firms in the weight-loss surgery industry.

No other potential conflict of interest relevant to this article was reported.

Oh, that’s okay. I think the conflicts already reported were quite enough.