Bariatric Surgery: Bad To The Bone

      48 Comments on Bariatric Surgery: Bad To The Bone

Bad news for the bariatric-surgery industry:  a Mayo clinic study released this week suggests that people who’ve undergone weight-loss surgery are more likely to break their bones.  Here’s the first paragraph from the wire story:

It isn’t just the thunder thighs that shrink after obesity surgery. Melting fat somehow thins bones, too. Doctors don’t yet know how likely patients’ bones are to thin enough to break in the years after surgery. But one of the first attempts to tell suggests they might have twice the average person’s risk, and be even more likely to break a hand or foot.


Given how aggressively the bariatric centers are promoting these procedures, I suspect they’ll put a good spin on this.  Pretty soon we’ll be seeing ads that read:

“The last time Mary Blarch broke her pelvis, she spent five miserable months in a size-24 cast.  But after shattering both legs in the year following her gastic bypass procedure, she’s practically swimming in her size-6 cast.  She only wishes there was more room for people to write their ‘get well’ messages on the plaster!”

I’m glad the study got some media play, but I have a bone to pick with the writer:  These people are not ending up with thin bones because they’re “melting fat.”  They’re ending up with thin bones because they had weight-loss surgery.  That’s a rather important distinction for a medical writer to make.

Here’s another fun paragraph from the article about the study:

A quarter of the 142 surgery recipients studied so far experienced at least one fracture in the following years, Mayo’s Dr. Elizabeth Haglind told the endocrinology meeting. Six years post-surgery, that group had twice the average risk. But in a puzzling finding, the surgery recipients had even more hand and foot fractures than their Minnesota neighbors, three times the risk.

It isn’t all that puzzling.  I don’t have a copy of the research paper, and the article doesn’t specify how many of the people studied were the victims of gastric bypass versus the lap-band, but I would guess gastric bypass is far more likely to produce brittle bones.  Here’s why:

The lap-band procedure squeezes your stomach down to a fraction of its former size – about the size of a golf ball. You lose weight because you are limited to tiny meals, which (if you’re following the recommended diet) consist almost entirely of proteins and non-starchy vegetables.  Yes, that would make it a low-carbohydrate diet.

Gastric bypass is much more radical.  The surgeon cuts apart your stomach and uses the top portion to make an itty-bitty stomach.  (They call it a “pouch”… isn’t that cute?)  The itty-bitty pouch is then connected directly to the middle of your small intestine, bypassing the evil duodenum.  And why is the duodenum evil?  Because that’s the part of your small intestine that aborbs fat.  The surgery centers that sell gastric bypass procedures even brag about this effect:

Gastric Bypass Surgery provides an excellent tool to limit the amount of food eaten and to change how food calories are absorbed.  Not only is the stomach pouch too small to hold large amounts of food, but by skipping the duodenum, fat absorption is substantially reduced.

Since people who have gastric bypass can’t absorb fats, they lose weight faster than people who have the lap-band procedure.  The gastric-bypass centers are quick to point this out in their literature.  Just one little problem:  you need fats.  Your hair, skin, nails, hormones and bones depend on fats, either directly or indirectly. 

As health writers like Sally Fallon and Nora Gedgaudas have pointed out in their books, many essential vitamins are fat-soluble, including A, B12, D, E and K.  If you’re not absorbing fat, you’re also not absorbing and using those vitamins — even if you’re filling your itty-bitty pouch with supplements. And if you can’t absorb those vitamins, you also can’t fully absorb the nutrients that depend on them, like calcium. Here are some quotes I found from studies that examined the effects of gastric bypass surgery:

  • The incidence of vitamin A deficiency was 69%, vitamin K deficiency 68%, and vitamin D deficiency 63% by the fourth year after surgery.
  • The incidence of hypocalcemia (low calcium levels) increased from 15% to 48% over the study period.
  • There is a progressive increase in the incidence and severity of hypovitaminemia (low vitamin levels) A, D, and K with time after biliopancreatic diversion and duodenal.
  • Dolan et al. reported vitamin A deficiency in 61% of patients following biliopancreatic diversion at 28-month follow-up. This was despite an 80% compliance rate with multivitamin supplementation. (Read that again: most patients took their vitamin supplements, but still became vitamin A deficient.)
  • Despite calcium and vitamin D supplementation after Roux-en-Y gastric bypass, Coates et al. found that within 3 to 9 months after surgery, patients have an increase in bone resorption associated with a decrease in bone mass.

So you end up losing weight, but also become vitamin deficient, and perhaps end up with brittle bones.  I’d rather be fat and know I’m able to roll on the floor with my rambunctious girls without snapping a femur.

But of course, you don’t have to become vitamin deficient to lose weight.  You can lose weight by cutting out sugar and starch, which don’t contain any nutrients we need – or to be more accurate, they don’t contain any nutrients we can’t get from the foods Mother Nature actually intended for humans to eat.

The lap-band procedure doesn’t block the internal absorption of fat, so it’s less likely to cause vitamin deficiency – and of course, the lap-band surgeons are quick to mention that advantage.  But as you may recall from a previous post, you’re still limited to ridiculously small portions.  I think it’s unlikely you can get all the nutrients you need from meals that could sit on a golf tee.

In fact, as I was wading through online research to write this post, I was reminded all over again of what an awful existence these procedures can produce.  Here are some explanations of the post-surgical effects – and keep in mind, I pulled these from sites that are actually selling the procedures.  Their explanations are in bullet points; my comments aren’t.

  • What is Symptomatic Dumping Syndrome? Dumping is caused by rapid passage of food from the pouch into the small intestine.  Before surgery, the stomach has a valve at the top and bottom, and serves as an acid-filled storage tank, breaking food intake down into small, component parts and passing it to the small bowel in increments.  After surgery, food passes directly into the small bowel, mixed only with saliva and amylase from the mouth, but no stomach acid. The small bowel responds by diluting what we eat through a process of ‘water recruitment’ into the bowel space. This is referred to as ‘early dumping.’  Suddenly, the heart will pound and beat rapidly; you may feel dizzy, and overwhelmingly tired.  The bowels may gurgle and churn, and will feel bloated and gassy.  This might be followed by loose stools and even vomiting.  It is not dangerous, but it can be frightening to the uneducated patient.

Yes, education is the key here.  When I was in college, I saw lots of educated people dumping and vomiting at parties, but they were never overly concerned.

  • Why is it sometimes necessary to vomit?  Your pouch and Roux limb, the two parts of the gastric bypass tool, work like a slow moving sink drain.  There is no stopper at the bottom of the sink, but the narrowness of the connection between the pouch and the Roux limb restricts the passage of food out of the pouch and into the Roux limb.  Sometimes if a food gets stuck and will not pass into the Roux limb, the only solution is to cough out the offending food to release it from the pouch. 

Coughing food out of your pouch … boy, that must make you popular at dinner parties. 

  • Why do some people complain of frothing after the surgery?

They actually gave one of those “it’s nothing to worry about” explanations, but I didn’t bother to copy it because 1) it was medical doublespeak, and 2) I was too busy laughing myself silly, picturing an obese, post-surgical woman frothing at the mouth … and her husband replaying the day’s events in his mind, trying to figure out what the heck he’d done wrong. 

  • What is Steatorrhea?  Steatorrhea is the result of fat malabsorption.  The hallmark of steatorrhea is the passage of pale, bulky, and malodorous stools. Such stools often float on top of the toilet water and are difficult to flush. Also, patients find floating oil droplets in the toilet following defecation.

So there you are, standing at the toilet, flushing and cursing and flushing and cursing and frothing at the mouth and risking a wrist fracture from all that yanking on the handle with your brittle bones, but your last meal insists on floating atop the water like a gang of pale, bulky, malodorous fishing bobbers. Sure, there are other options besides flushing, but they’re not pretty, even if you believe in composting.  And to make matters worse, there are oil droplets floating around the bobbers.  Best remember not to toss a burning cigarette butt into the bowl.

  • If a LAP Band patient nibbles on food all day, he or she can continue eating a high-calorie, high-fat diet without ever feeling full and never lose weight.

Uh, no.  If a lap-band patient nibbles on high-fat food, he or she will feel full.  If he or she nibbles on carbohydrates, he or she will spike his or her insulin and then he or she will feel hungry and he or she will nibble again … and again … and again.

  • Also note that hair loss is common – but don’t worry, it usually grows back within a year. 

Which gives you plenty of time to color-coordinate your smaller clothes with your new wigs.

  • If you are a regular coffee, tea, or soda drinker you should be aware that no caffeine is permitted for the first three months after surgery. 

So I’ll be nice and thin when I’m sent to prison for aggravated assault.  But I’ll also be bald, so maybe I’ll look badass enough to avoid any unwanted romances.

  • Considering whether to undergo Lap Band surgery requires serious thought. It should only be considered if morbid obesity is a major medical issue and nothing has worked. 

Really?  I thought you should only consider lap-band surgery if you think dieting sucks.

  • Remember, weight loss surgery is a tool!

So is the surgeon who performs it.

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48 thoughts on “Bariatric Surgery: Bad To The Bone

  1. Laurie

    Bones are an amazing, dynamic tissue. I don’t know too much about them except they are not inert and they have a significant fatty component. They are constantly undergoing remodeling. They’re a storehouse for all kinds of important compounds. The yellow marrow is fatty. I guess because they appear static, they are not appreciated like their frenetic tissue cousins. When a bone breaks, the tissue can undergo something called de-differentiation. The cells can literally return to their embryonic developmental state to effect repair. Messing with fat digestion and absorption with bariatric surgery is a recipe for disaster and it’s stupid. The fats in our diet are not the problem. Our health care system is a sham if the recommendation to cut out the substance, FAT, that sustains our brains and all organ systems has become the bogey-nutrient. This is a stunningly egregious state of affairs.

    I’m not big-boned, but I’m pretty sure we’re all fat-boned to an extent. If marrow is full of fat, there’s a reason for it. Mother Nature isn’t stupid.

  2. TonyNZ

    I can’t find the paper for the life of me, though it is narrated in terms of a meeting or conference so I suspect this hasn’t made it through the peer review process. I’ve been reading some of Mike Eades’ older posts recently and there was one where he savaged someone for taking evidence from a conference proceeding. Then again, It really irks me when journalists refer to studies yet don’t give enough information for people to find the studies to which they refer.

    The text in the article seems to indicate that lap band produces less thinning than bypass, so the fracture assumption you make is probably correct.

    I’ve never broken a bone, so all that full fat milk must be alright for them. I had a 200kg stage riser fall on a leg once. Intramuscular bruising, but no break.

    Great annotations to the post surgery effects. Laughed a lot at that one.

    I figure conferences are fair game for reporting, but I wish media reporters in general were more scientifically astute or at least more skeptical. The only thing about this piece that annoyed me was the “melting fat thins bones” statement. Until people who lose weight without surgery also start breaking bones, that’s kind of a dumb statement.

  3. Dave

    Great post, and fantastically gruesome X-ray.

    I wonder if these patients also experience an increase in cavities? That would follow from the lack of fat-soluble vitamins. I’m sure the same doctors encourage them to stay out of the sun, so now these patients have no source of Vitamin D. Broken bones, bad teeth, decreased immunity, increased risk of cancer – but at least you’re thin!

    I came across a post-surgery support group, and one guy was in fact complaining that his teeth hurt all the time.

    1. fatagain

      I had rouen-x done in 2001. Lost 210 lbs in 6 months. Looked like a really skinny sack of saggy skin, drooping everywhere over quickly decaying teeth, brittle bones, hair loss, hormonal imbalance,and chronic dumping for 12 years. Suddenly, I am fat again. My teeth are decaying below the gum level, and my pouch is still intact. Another question that never gets asked by the medical field is rhe effect of this drastic, temporary, weight loss procedure has on psych medication. I am ready to tell my story of the hellish lifestyle I now have as a result of medical irresponsible the decision to promote any “all, or nothing” surgery.

  4. JaneM

    I’m so glad you posted this. Teenagers are now being encouraged to get bariatric surgery. I am certain that they (and their parents) are not being fully informed about the risks. Teens are still putting on bone mass and it appears bariatric surgery would put them at a particular disadvantage. Young women need to know that their childbearing years could be severely compromised, not to mention middle-aged ones having such a greater chance for fractures.

    Yup, I saw a “news” story online — obviously written as bariatric P.R. — in which some teenage girl explained how much better her life is after weight-loss surgery. In the pathetic attempt to make it look like a real news story, they quoted a doctor about the possible downside. He warned that some teenage patients have a difficult time adjusting to all the new attention, moving into a new social group, etc.

    How’s that for journalistic balance? “Well, you’ll lose weight and look awesome … but on the other hand, you may have to put up with people fawning over you and adjust to dating hotter guys.”

  5. Vin - NaturalBias

    To me, it’s common sense that interfering with the bodies digestive system in a way that promotes calorie restriction and especially impaired absorption is going to cause significant problems. I guess some people are so desperate to lose weight and are so deprived of the appropriate information to do so that they need dramatic examples such as broken bones to make them realize this approach isn’t a good idea.

    I think it’s great that you pointed out the variety of nutrients needed for healthy bones. There’s far too much obsession with calcium, and as a result, many people are missing the big picture of osteoporosis and some are even causing additional problems with excessive supplementation.

    I love the last line about the surgeons. 😉 I ordered Fat Head last week and can’t wait to watch it!

    That’s one of those important distinctions: ingesting a nutrient doesn’t necessarily mean aborbing it. Pre-agricultural humans had thick, strong bones, but I’m pretty sure they weren’t milking wild yaks or popping calcium pills. However, they ate lots of fats.

  6. Amy Dungan

    Why do I have the feeling your astute observations on this topic will be ignored by those who still think dieting sucks. I use to think if they’d only realize that through these procedures they are being FORCED on a diet, and low-carb no less, they’d change their mind and just try low-carb. Sadly, that rarely happens. I have several friends who told me they just couldn’t stick to “that diet” and then had surgery, only to be stuck with “that diet”. (They’d say “that diet” like it was a dirty word.)

    Low-carb or vomiting. Low-carb or brittle bones. Low-carb or hair loss. Low-carb or foaming at the mouth like a rabid animal. Hmmm.. such a hard choice!

    I guess they’re like the dieters’ version of the people who joined “Quitters, Inc.” in the Stephen King story … giving someone else permission to hurt or even kill them if they don’t stop smoking.

  7. ethyl d

    Ewww. I made the mistake of reading this on my lunch hour while eating my lunch. A lot of gross info, but I laughed a lot.

    Do you think there may come some age in the future when medical science actually does have a clue about how the body works and doctors then will look back and laugh or shake their heads over all the incredibly dangerous things done during the late 20th-early 21st centuries that doctors promoted as safe? “Back in the Dark Ages, when they believed cholesterol caused heart disease and low-fat diets were healthy….Why they even performed surgery on people to keep their bodies from absorbing fat!” Dare we hope? It’s just so sad how much people suffer at the hands of people who are supposed to be the ones helping them.

    I think there’s a tendency in every generation to think the previous generations were ignorant, but we’re all enlightened now. Given the rapid advances in medical technology, it’s an easy mistake to make: Hey, we can do heart valve replacements … we know everything! But obviously we don’t know everything, and I sincerely hope future generations laugh at our current ignorance about diet, cholesterol, fats, etc. — because if they’re not laughing, they still believe in it.

    1. Walter Bushell

      Ah, yes. The Star Trek movie, with the whales.

      UHURA: He is not expected to survive.
      McCOY: Jim, you’ve got to let me go in there! Don’t leave him in the hands of twentieth century medicine.
      SPOCK: Admiral, may I suggest that Doctor McCoy is correct. We must help Chekov.
      KIRK: Is that the logical thing to do, Spock?
      SPOCK: No, but is the human thing to do.

      Lard help us, one and all, even the statinators; we are at the mercy of 21st Century medicine.

      GILLIAN: How?
      McCOY: Well, we’re gonna have to look like physicians.

  8. Ryan

    In your research, was protein mentioned anywhere? Protein is normally broken down in the stomach for digestion so having the food just fall through the stomach (dumping) sounds like a really bad idea. Maybe a big part of that quick weight loss after surgery is muscle.

    There would have to be muscle loss as well. We’re talking about big people having their capacity to eat reduced to a few ounces here and there. Even if it’s all protein, it couldn’t be enough.

  9. Brian

    It still amazes me that people will read this, consider the possible side effects and still go through with it. When I consulted for a hospital group here in Houston, people coming in for bypass were desperate. As if no other way existed. But they sure would get on the Atkins like shake until their liver was better, just to have the surgery.

    And Vin beat me to the punch – but the doc’s that do these surgeries are tools!


    Somewhere in my Fat Head research stacks, I have an article about how fear of being obese ranks nearly as high as fear of death. A surprising percent of people polled would sacrifice two years of life, or a foot, or their hearing, etc., to avoid being obese. I never liked being fat, but give up two years of life?! Two years of hanging out with my wife, two years of seeing my girls become adults, maybe two years of spoiling my grandkids? It’s insane.

    Just shows how fat-phobic we’ve become … even as more people are getting fatter.

  10. TonyNZ

    “A surprising percent of people polled would sacrifice two years of life…to avoid being obese.”

    Man, being obese is so bad. It cuts your lifespan by like a couple of years (lets assume this were true). I would totally cut a couple of years off my life to avoid that fate.

  11. agnostic

    Not that I favor expanding the scope of credentialism, but we really should license and regulate journalists like we do other professionals who can substantially influence the consumer’s well-being.

    For example, you’d have to pass a basic numeracy test, since numbers show up everywhere — unless the reporter is too afraid of numbers to look them up.

    And health / nutrition reporters couldn’t publish an article without investigating the topic on PubMed, OMIM, or whatever.

    Of course, you’d have to pay higher salaries to get this higher quality, and so you’d have to charge more for the product. But the demand for data is pitiful — that’s why everything out there (newspapers, books, TV) rarely has numbers, let alone all of the relevant numbers, or graphs / charts that explain what’s going on.

    People much more prefer charismatic gasbaggery than a clear description of what the data say.

    I wouldn’t want to get into restricting the 1st Amendment freedom of the press, but I wish news organizations would require some scientific literacy tests for health writers, some economics tests for political reporters (most of whom know diddly about economics; trust me on that one), etc.

    In the meantime, that’s one of the great advantages of the internet age. The “pajamas media” can bust bad reporting. Just ask Dan Rather.

    1. Walter Bushell

      No! No! No! A thousand times.

      Just imagine if journalism were restricted to government approved journalists.

      There is “NO PROBLEM” so bad that government can’t make it wurst. And this is one that government would use to make sausage of freedom of the press.

      And TV news and most newspapers are entertainment. Scientific literacy for what it costs money and is a buzz killer.

      Bad enough government can tame journalists, by restricting access to those who don’t at least genuflect to the official egos.

  12. Lisa Sargese

    As a survivor of both gastric band AND gastric bypass I consider myself an expert on the devastation of these surgeries. Lap band patients suffer especially because they tend to vomit 2, 3 or 4 times per day. Course protein gets “stuck” in the band easily so banders tend to go for the smoother, easier to digest carbs. I wish they would also do a study on tendons, ligaments and other injuries that WLS (Weight Loss Surgery) people endure. I ruptured a tendon this summer and am in a wheelchair. No one likes a balding cripple, trust me. Good thing I found Weston A. Price people to help me nourish myself back to health. Lots of digestive enzymes are helping me to actually absorb the nutrients that escaped me the first three years after my bypass. Once I’m healthy I expect to be a LOUD activist against WLS and weight loss diets in general. Thanks for a great blog!

    Sounds like a terrible experience. I’m curious, though: how did you end up having both procedures?

  13. Dave in Ohio

    I’m musing over what folks a hundred years from now will think of these bariatric procedures and the doctors who performed them. Probably about what we think of medical practices from the middle ages. Seems like something out of a horror film involving ritualistic mutilation. Cutting out part of a human’s intestines. Yikes!

    Seriously obese people have *naturally* gained enough weight to become that way — they didn’t go out and say to themselves, “let me eat and eat and eat until I’m obese. I’ll be a lot better off that way.” No, they do what everyone else does — they eat until they’re satisfied, until their bodies tell them they’ve had enough. So why is the medical establishment ignoring you, Taubes, Eades, Davis, et al.? Are they seriously interested in their patients health and quality of life or are they just out to grab as many health-care dollars as they can before the teller’s window closes?

    Side note on Spurlock. Undoubtedly, ten pounds of so of his weight gain was just water due to the excess carbohydrate, and another few pounds was due to additional food in alimentation transition. So, his actual weight gain (maybe 12-14 pounds) seems possible. But I’ve noticed when I occasionally pig out, two things happen. One, my body burns up a lot more energy — I feel much warmer, sometimes to the point of sweating at night. And second, I wake up earlier and sleep poorly. It’s as though the body was doing it’s very best to burn off those extra calories as quickly as possible. (I haven’t tried Spurlockian proportions day after day, though.) And on the opposite hand, when I eat too few calories (as on a low-calories diet and as shown in Fat Head), my limbs feel cold, I’m listless, and sleep more. It’s as if the body is constantly syncing itself to the level of energy intake.

    So when is Fat Head II coming out? 🙂

    Lots of things about Spurlock’s weight gain don’t make sense. You may recall he lost a pound between weeks three and four, but still managed to end up 25 pounds heavier overall.

    But what I found most fascinating is that it took him so long to lose the weight. A young healthy male, trying to lose weight he’d just gained and therefore wasn’t pre-disposed to carry in the first place, yet it took months. So much for that great vegan diet.

  14. Dave in Ohio

    Uhh, just saw that ethyl d. had the same thought about history’s view of all this. And boy, how I agree with you that mankind always seems to think they now have it right compared to those backward folks from the last century. I suspect pre-agricultural humans were a lot smarter than we give them credit, maybe smarter than we are today.

    I think we confuse technological advancement with intelligence and/or enlightenment. I wouldn’t be surprised to learn (if it were possible to learn) that people were smarter back in the day. Stupidity probably got you killed, or at least excluded from the gene pool.

  15. Matt Brody

    Fact: All physicians must take the Hippocratic Oath. Is this a fact, or is it just hollywood that makes me think it’s a fact? Because it can’t be a fact due to the following fact:

    Fact: Bariatric Physicians routinely perform a surgery on individuals younger than 75 which is guaranteed to reduce vitamin absorption permanently.

    But haven’t you seen the literature? They’re helping people overcome obesity, diabetes, heart disease — and even cancer now! (I read that one yesterday and may post on it soon.) Heck, I’m thinking of having my stomach removed completely so I can avoid cancer.

  16. Lisa Sargese

    Hey Tom, I had the gastric band (not called LAP back when I had it done in 1988 when it was still being performed with full open incision). I vomited so much that the band was no longer adjustable as all the saline had been removed to make it looser and looser to accommodate the swelling of my constantly puking stomach. The Dr. (Lubomyr Kuzmak who was the first surgeon to do adjustable gastric banding back then) replaced it entirely, again with a full incision surgery. That band sprang a leak. I refused to go under the knife to have that one replaced. Gained all the weight back plus 100 ballooning me up to a full quarter ton. 13 years later I had the old band removed (scraped out of me along with adhesions and scar tissue) nearly at the expense of my life and had the gastric bypass. Now I’m fighting for my life again as my body, still fat, is suffering from malnourishment due to low fat dieting and malabsorbtion.

    Good lord, what a horror story. I’m sorry to hear you had to go through all that … and I take it being an “educated” patient didn’t make the vomiting any less frightening.

  17. TonyNZ

    @Matt Brody

    It’s all about belief. They don’t believe they are doing harm, so they are not breaking the oath.

    If I believe something, even if it is not true, I can say it under a perfect lie detector (not the unreliable ones they have now) and it wont trip.

    That probably makes it more scary in some ways.

  18. Jason Sandeman

    Tom – I actually almost shat my drawers reading this. LOL. Great insight into a growing problem.

    The worst part? People are not sure at any given moment what to eat and drink! Unless it is made by Kraft (big tobacco anyone?) Don’t eat it. Unless it is made by Nestle (Coca-cola) don’t drink it! It will not be healthy for you!

    Irony of ironies though, your adsense is now advetising the surgeries. LOL!

    I noticed the Adsense ironies. Google pops in whatever fits their algorithms, I guess. Ads for diet plans or diet books by Dr. Oz have also shown up, despite how often I’ve written that Oprah needs to get away from him and his lowfat diet nonsense.

  19. Debbie

    Another good reason (among many) to avoid weight loss surgery. Even though I have been virtually stalled for MONTHS on a strict low carb diet (not a single cheat, no grains, no sugars, no polyunsaturated oils, carbs in the 20-50g/daily range) despite still having well over 100 pounds to lose I still can’t imagine having weight loss surgery. Though I do admit to being depressed wondering why low carb is not working now for *me*. Heck, I feel good – but when you have 100+ pounds to lose you want to see the scale dropping also. 🙂

    As for fear of fat? I wish I could remember where I read it, but I remember reading once that more people said they would abort a fetus if they were told the baby would grow up to be fat than said they would abort if the child would have some serious medical complications.

    They’d abort a fetus they knew would grow up to be fat?! Good lord, that’s sick. People who think like that would’ve denied the world Ben Franklin, Winston Churchill, Jackie Gleason, John Belushi, John Candy, Chris Farley, Dom DeLuise, many of the best chefs, countless opera singers, not to mention millions of ordinary, decent people who happen to be fat.

  20. Laura Preston

    They say ignorance is bliss….your life must be very blissful.

    Until you have lived in a morbidly obese body, I do not understand how someone feels they can stand on a soap box. Until you wake up thinking you can’t stand living in that body one more day….until you have walked that walk…how dare you comment as if you know? Do you tell a heroin addict you understand what it is like to be high if you have never experienced it? Do you tell and alcoholic to “just have one”….

    Medical articles are helpful. Ignorant opinions are not.

    ** 4 year Gastric Bypass patient that has perfect labs and has maintained a goal weight. I consider myself a recovering food addict that sought treatment.

    Glad you’re happy with your results. But I’m curious: considering much of the post included quotes from academic studies — not to mention text lifted directly from web sites for medical facilities that sell the surgery — what specifically struck you as an ignorant opinion? Which facts cited do you dispute?

    I’ve also heard from many people who have been in your shoes, underwent the procedure, and now believe it was a horrible mistake. Surely you don’t consider their opinions ignorant … ?

  21. Mike

    one thing that worked for me in losing weight was cutting out soda. I lost 30 lbs from feb-june doing nothing but cutting soda.

    With all the sugar in soda, I can see where that would do it.

  22. Rhonda Lanry Krantz

    I really agree with you Laura Preston. These people are blindy commenting without really KNOWING or understanding, either do not know, do not know enough or are going by or have alot of incorrect and/or simply misleading info especially on the web(lots of incorrect info on the web from people who claim to know but do not). Unless you have lived the life of obesity ( people who comment negatively about overweight people and have no idea always assume all obese people eat too much and the wrong things, are food addicts etc . )These people are ALWAYS or almost never people who have ever had a weight problem and assume FAT , yes I said FAT people are gluttons, greedy and LAZY.They also assume that what works for one or even the majority works for all, not so.Also, do you really think anyone that gets any type of weight loss surgery did not consider, research and evaluate it before hand, no you probably did not think that. Obviously it is percieved we choose surgery because they/we are lazy, lack intiative and plain old want the easy way out. Obviously people who are commenting think these things.Do you realize the cost $20,000.00(almost always have to pay for it ourselves I did, few insurances help).Why do people who do not have this problem even come to this forum, obviously not to support or encourage, they need to analyze that more, not why obese people try to better thier health and lives. I am a 52 year old woman that is very intelligent and active. I work with Foreign exchange stuents, educators etc. I am not stupid as is thought of obese people as well ( I mean after all we would not be fat if we had the sense to not over-eat and eat healthy, right?). I was top of everything in school and after, was head cheerleader, drill team, all honors, president of every club you can name. Self employed, but always had a struggle with weight, even though I always ate well, exercised, salads, veggis, sugar free this, salt free that, my mother and everyone in my family does not like, use or buy salt sugar high fats,it is a personal preference. About 15 years ago I was going through something very traumatic, being treated for PTSD. I went to therapist 2 times week when she noticed I was gaining astronomical amounts of weight in days, she personally took me to ER. I also went to another doc to tell him I was feeling really bad, exhausted and hyper, racing heart, sweating, mood swings,cessation of menstrual cycle, ferociously hungry, passing out, weakness , bulging eyes, dry eyes. First it was thought I had hypothyroidism because I was fat. After trying everything I could, then researching bariatric surgery for 10 years while still seeing nutritionist and eatting 6 eggs whites a day because I lacked protein. The doctors said then that I had all the signs of hyperthyroidism as well.But this could not be possible, I was fat, they giggled, how rude and condascending! I continued dieting, exercising, drinking protein drinks which I love.Also all I ever ate was grilled lean meats(blah, do not like meat) and veggies with Smart balance as always because I like the way it tastes.I continue to gain lots of weight. When I could not take it anymore I exhausted all other avenues I went to a Bariatric surgeon to start the process, I used my savings (part of it) because my quality of life became less than desirable.My pre-op test showed I had very little if none thyroid and parathyroid hormone, meaning I had hyperthyroidism, it is believed you are always extremely skinny with this, the doc my pcp laughed again and said no way. I said hell with it I need this weight off before it affects my health. I had been passing(years) out regularly since I first told docs my symptoms and they said no way you cannot have hyperthyroidism and be fat. So I had an extensive heart work-up done, my heart is fine. I had and still have low-sugar, low blood pressure(recently alarmed it was way too low, low cholesterol, my lab works were and are indicative of how I eat which is very healthy, but, my weight gain was not. So I had the surgery, was great is great, lost 110 pounds as of today.I guess I am not a obese, a FAT ,LAZY, OVER-EATIING, UNDER_EXCERCISING person anymore because doctors are paying attention, looking further, I have been diagnosed officially with Hyperthyroidism even though I am still not skinny skinny also, they believe I am alternating between hyper an hypo. Every blood test I get lately, several in last month is worse and worse. I am on meds heart meds to slow my heart down and valium until my appt with my Endocrinologist because the racing heart is bad. My point is this, obese people have many metabolic problems that get overlooked because everything is blamed on being fat.Doctors and people who like to comment need to look deeper and past the fat and realize that obesity is a symptom of another disease , many and most times it is not the cause.Look at me and wonder “What is wrong that is causing her obesity and weight gain”?Not just assume that the problemis that she is so fat, she eats too much.. We are people who want the same things and decencies , lets not forget good health and understanding in life. Why do people find it necessary or easy to discriminate and assume?It is now a problem that these metabolic conditions untreated and undiagnosed have and are having unpleasant and possibly serious reprocussions, causes death.. Undiagnosed metabolic problems can and more often cause death, deaths blamed (narrowmindedly) on obesity, when it should be askedd before it is too late, “What disease caused this person’s obesity and death”? You know and I know, as sure as I am sitting here typing and you are reading and maybe even smirking condascendingly, that when a fat person dies it is almost always said ”
    she or he did it to themselves”. When in all actuality it may be so to a small degree, but, more than likely it is because that person was over-looked, undiagnose, mis-diagnosed, neglected or discriminated against simply because they were fat. What does that say about you or them? I will never regret spending the money and having the surgery, number one my health is far better, I lost weight, but most importantly doctors are paying attention. If you wish to write me my e-mail addy is I look forwar to educating you and changing your way of thinking or should I say your ASSUMING.

  23. Rhonda Lanry Krantz

    Forgot to say I do not and never did drink sodas, diet or otherwise ( just too syrupy, sweet, carbonate or acidy, I drink and love bottled water all day, take it with me, even to bed. Sometimes I drink Crystal Light, but prefer icy water.Do not drink alcohol(well occassionally a good bloody mary …lol), never did drugs recreationally. Living a healthy life is important.I o drink onje cup of coffee in morning ith Splenda, sugar makes it too thick, sweet, syrupy, changes the consistency totally.

  24. Dana

    Rhonda, you said:

    “People who comment negatively about overweight people and have no idea always assume all obese people eat too much and the wrong things, are food addicts etc .”

    Well, if that’s not true, WHY DID YOU HAVE THE SURGERY? Obviously if it’s wrong to think an obese person is a food addict, then there’s no damn reason to maim yourself permanently so that you eat less. Right?

    Guess what? I’m a hundred pounds overweight. Not sure if that qualifies as “morbidly” obese, though I suspect it’s close, at least. But yes, I DO know what it’s like to be fat. I’ve also known what it’s like to be thin so I’ve been on both sides of this. And you know something? They will never get me on that table to lose over half my stomach. No way in hell.

    Now I’m gearing up for a major push to lose this weight and if I am successful this time around they MAY get me up there for a tit lift and tummy tuck because damn if I’m going to go around looking like a raisin the rest of my life… but those things will not malnourish me the rest of my life, or leave me vomiting and shitting my pants.

    Great for you that it worked out for you. Why do I suspect you’re in the minority, though?

  25. Dana

    Let me add that although I sometimes eat a large meal, I am one of those fat people who doesn’t *habitually* eat huge amounts of food. I sometimes forget breakfast, even, and have since I was a teenager. I did have a mean full-sugar soda habit for years and years, but I’ve largely kicked that. My endocrine system is just messed up from years of caffeine abuse and carb overconsumption and God knows what else. I’m pretty sure reproductive hormones played a role too since I gained the most weight after being on the Pill or pregnant.

    Women’s bodies are so damn complicated… especially mine, it sometimes seems.

    I’m just playing devil’s advocate. One of you pro-butcher commenters said it was a food addiction, the other insists it is not. You can’t even get the story straight. You know, I always assumed an addiction was a habituation to a substance one does NOT need. You need food. You especially need some of the foods that your body won’t let you eat now.

    I feel the same about people who take alli. But at least that’s reversible. Assuming the drug doesn’t kill you, of course. I’ve heard some bad things about it.

  26. Paula Wiggins

    I think this is a very biased view of weight loss surgery. My own opinion is that people should not undertake it unless they are morbidly obese and have been unable to achieve and maintain weight loss by other means. Most of the insurance companies feel the same. I am not advocating weight loss surgery for people with a small amount to lose (by small amount I would say under 100 pounds) but for some very obese people, I do believe it is life-saving.

  27. Stacey

    I had gastric bypass 2 years ago. I have never coughed food out of my pouch, nor have I vomited since surgery. People’s bones break because it is a malabsorptive surgery meaning the body can’t get the nutrients it needs from food because food passes through the body rather quickly, people need to take calcium pills every day along with other vitamins for the rest of their lives.
    Yeah dumping sucks, but you control that by eating the right things, DUH. Eat what you shouldn’t have, your heart races and you go lay down. 10 minutes and I am fine again. I just skimmed your article because I’m searching for something else, but thought I’d come comment because I live this.
    I lost hair, but it was nothing compared to being FAT. Id rather be skinny with new hair than be fat with all the hair in the world.

  28. Maya

    I’ve lurked at a few obesity boards just out of curiosity and have noticed a trend: those who have had weight loss surgery seem to expect external forces to do the work for them. The surgery will cure whatever ails them, their surgeon is praised like a savior and if something goes wrong it’s all his/her fault (may or may not be), their mottos are “let go and let God”, “God has a plan for me”, the theme seems to be “YOU fix me!”

    I read the non-op diet and exercise forums and the attitude is different, they don’t make excuses, they don’t expect others to “fix” them. They just do what they need to do and they get results – without carving up their digestive systems and without expecting others to do the work for them. They have bumps and failures but they pick themselves up and keep going.

    What gets me the most is that often the doctor will put the WLS-ers on a diet before their surgery to get down to an operable weight. Funny how they couldn’t diet before to save their health but now they suddenly can lose 25, 50, 80 lbs for a chance to worship at the altar of their surgeon. Gotta love the irony.

    Great article Tom.

    I’ve heard of cases like that; they go on zero-carb liquid diets to lose weight, then have the surgery. Why, for pete’s sake, would you do that to yourself when you just proved you can lose weight without it?

    1. Cecilia

      They, that is to say, I would “do this to myself” because every attempt to lose weight, including a run at Atkins that was so successful they flew me out to NY for a photo shoot and I was on the cover of their magazine back in 1998, is not permanent, and results in gaining back all the weight and then some.

      Your comments are hurtful. You mock people by saying they are “frothing at the mouth, breaking their wrists trying to flush the toilet, etc” Until you’ve walked a mile in my shoes, you can’t really understand what I’ve been through.

      My comments are indeed intended to scare people away from this barbarism.

  29. Docholly

    Well this explains why 21 years after gastric bypass surgery (otherwise known as the dark ages) I’m sitting here with a fat ass and no teeth. I, nor my dentist who I saw faithfully 2xs per year, could figure out why my teeth were breaking. It really never occured to me to tell him that I’d had WLS. It started about 8 years ago. Luckily my bones haven’t been effected, yet. About the time the weight started to come back on, even though i still walk 10 miles a week, drink about 2 lts. of water per day and still cant manage more than 6-8 oz of food per meal.

    I’m sorry to hear about that.

  30. Jerry H.

    I am so glad too see that my family is not alone. What I am trying find is some possible direction as to resolving some issues with my wife’s complications from this “Frankenstein” procedure known as “Rouen Y”. A name that is so fitting as it potentially “Ruined” my wife’s chances for a longer life. She had this procedure done approximately ten tears ago. Since day one there have been problems with keeping almost any kind of food down as well as absorbing the needed vitamins the the duodenum would naturally do. So she tried vitamins orally and through injection with little to no effect. Then started to experience the hair loss as explained in previous posts. this was only the beginning, through the years these things that be considered minor escalated to life threatening proportions. I will skip to the now current symptoms:Bile reflux , which is a real biggy with this surgery that they tried to cover up as Acid reflux and prescribed the much overpriced “Karafate” (strong liquid antacid) and “Dexilant” (strong pill form antacid). This was a very good fix so it seemed as this was only to be taken temporarily as the doctor said would clear up and go away. So problems got worse and persisted and had my wife checked with a scope. turns that she had a small ulcer (another common ailment from Rouen Y) where her stomach connects to lower intestine. So we were told it would heal up with the above antacids and it did temporarily again. My question is how do you have and ulcerated heal up when it has to expand and contract on a daily basis. I believe there is some faulty surgical work here. We have been told that she can not take these antacids forever and that nothing can be done. So another words i have to watch my wife slowly die from malnutrition and dehydration. Can anyone advise possible legal direction with something 10 years old??

  31. energybalance

    From Sydney, Australia

    Writing from Sydney, Australia

    Friend of mine last week is now recovering from the latest greatest method of weight loss surgery(haha) .. why not just remove 70% of the stomach entirely (stomach sleeving). oh hear. surely thats worse than banding and bypasses.. Does this mean this friend is ready to face all the same problems like malapsorption, vomiting etc etc.

    and of course its irreversible . once they take it out they cant put it back. Surely all that tissue, stomach has a role in good health?

    If only my hypnotherapist friend could have got her to get to the root cause of the problem first.

    1. Cecilia

      Please do your research before commenting. They don’t remove 70% of the stomach. A few key-strokes on Google will show you what Roux-en-Y really does.

      Google takes me to articles stating the remaining itty-bitty stomach is the size of an egg.

      1. joey bagadonuts

        Celia, you ignorant slut. The poster was clearly referencing the Vertical Sleeve Gastrectomy, not the roux-en-y.

  32. MAtl Y

    commaybe most of your fat f**** who just gave up feel good making fun of the surgery what I am400400and will die in a few years so the surgery is well worth it oh I forgot dieting is so easy that’s why all of you did instead of getting surgery hypocrites

    I see the surgery not only creates brittle bones, it also removes all ability to employ punctuation in a sentence.

  33. Razwell

    Hi Tom,

    You’re right. This surgery does not work anywhere near as well as advertised. Dr. Jeffrey Friedman noted this many times during his lectures.

    That the “successful” patients are still loaded with fat ( although less massive in overall size and somewhat less fat). They are just smaller versions of themselves. Fat specifically is regulated by hormones. These successful patients still have a shockingly elevated body fat percentage. None of this is a criticism of the patients or what they have been through. Rather, it is a criticism against medical doga and beliefs.

    This observation alone is an indictment of the caloric hypothesis. It also shows us how complex obesity is.

    Take care,

  34. Wimaju

    There is no balance on this site.
    I had Roux-N-Y 14 years ago.
    I am 55 years old.
    I had no complications; have mild dumping only if I eat sugar/dairy together and that has lessend over the years.
    Have no physical problems.
    Take no medications.
    My blood work is checked annually and remains good.
    My recent dexa-scan for bone density was normal despite family history otherwise.
    I have only regained 10 lbs. from my lowest weight.
    I exercise more that I was ever able to before.
    I would do it again without a moment’s hesitation.

    And BTW, I eat whatever I want to until I am full and then I quit.
    I do not restrict myself food-wise in any manner.

    1. Tammy H

      I agree. I also had the Roux-en-y surgery 11 yrs ago. I lost 200 lbs and have only gained ten pounds back in my 11 yrs. I take my vitamins religiously and I eat till I’m full. But, I can NOT eat sugar, milk, or carbonated drinks. I don’t smoke or drink at all. I became lactose intolerant after the surgery. My worries is, even though my blood work is always perfect, why is my feces floating sometimes after I go to the bathroom? They say that It is a sign of malabsorption but my Dr says I am not. I also don’t have pancreatic problems or celiac disease which is also a reason for feces to float in the water in your toilet. Can anyone tell me if they are experiencing the same thing? I am also fatigued on a daily bases. Keep in mind that I have always took my vitamins religiously from day one. I take a multi vitamin, fish oil , CQ10, chromium pic., vitamin D3, B complex, milk thistle and I get One B12 injection once a week. I have taken these for 11 years and when my blood work is done , I am not lacking in any vitamins. I have also had a bone density test and it was fine as well. My cholesterol has always been exceptionally well for some reason but I guess because I’ve never been a fan of fried foods or meat( especially pork). I also never liked the protein drinks but I tried for a very long time to drink all kinds of them. My hair does come out , I noticed, but nothing outrageous. I am not balding at all. This is my experience with my weight loss surgery. I am glad I did it because it changed my life for the better. Thankfully I can’t eat sugar or I get really sick! So I stay clear of sweets. Some people are able to eat sugar with no problem. I think that could be a reason as to why some patients (WLS) gain their weight back. Plus if you constantly eat more and more , you can stretch your stomach back out. I eat till I’m full and stop. I don’t want to stretch my stomach out. So I guess the only major problem and concerns are my feces floating and not sinking like it is supposed to. My vitamin intake and if it’s actually being absorbed since they say you can’t absorb nutrients any longer when you eat. I don’t understand why you can take vitamins and they will absorb… that’s a concern I’ve never gotten a straight answer for and believe me I have tried. My other concern is my constant fatigue. I’ve had my thyroid checked and anything else that causes fatigue checked with no answers. Could it be that I’m taking all of these Exspensive, quality vitamins for nothing? No one should feel as tired as I do every day. I push myself to exercise to feel better and I eat healthy. Maybe it’s because I don’t drink enough water in a day… the only thing I drink is organic green tea and water. But I struggle with getting enough. Also my sleep is horrible. I wake up every 2 hrs and wake up exhausted. I know I will be told to go to my Doctors with all of this and I will respond by saying- I already have- many times throughout the decade I’ve had to endure these issues and concerns.

  35. Linda

    Thank you, Wimaju, for being the voice of reason. The comments here are so ignorant. Of course there is the possibility for complications and of course the surgery might not be the best answer for everyone, but it does work for a lot of people and improves quality of life significantly. I have had gastric bypass and it was the BEST decision I have ever made. I lost over 100 lbs, and my blood work always comes back normal and healthy. Before surgery I was vitamins deficient; I still remember a doctor looking at my lab result with disbelief because I had such a lack of vitamins and supplements. After surgery, my levels are all in the normal and healthy range. Also, I have never had a “dumping” episode, even when allowing myself something sweet. Not everyone will get dumping. I was headed to an early death, I hated the way I looked, and never had any energy. Now I’m healthy, love myself and I workout every day. So much for gastric bypass ruining people’s lives. It saved mine and many many others.

  36. sarabrenner

    Alli is a horrible product. I only lost a small amount of weight, and even then, the stomach discomfort was not even close to worth it. There are much better alternatives out there. I switched over to the Lady Soma Detox and started dropping weight like crazy..and my stomach feels much better. Alli is a joke.

  37. wubbsy

    Surgery for this seems so stupid and dangerous. Even DNP 2.4 is safer and more comfortable, not to mention cheaper as well…

  38. Lara McLucas

    Hi Tom,
    It is really a great article. It helps us more to get the best information about bariatric-surgery. Definitely I was not aware about this kind of effects of bariatric-surgery. I am very glad to go through your helpful article. Thanks for sharing a nice blog.

  39. Don

    I am seriously surprised at those who had horrible experiences with these 2 procedures probably are t being honest and telling you that they didn’t follow the nutritionist or supplement regiment. I had R&Y in 2007 when from 350 lbs to 197 lbs and guess what I am ?? feel great and no broken bones. Those who are having issues I would bet they had issues before surgery. Probably long before the surgery. So before you start cutting and pasting passages from articles to attempt to prove your point just don’t have the surgery nobody is forcing it on anyone. Shit you have to go through a lot of hoops before you can even have it. Atleast I had to meet with doctors, nutritionist, psychiatrist as well all this to insure I was a stable candidate for the surgery so there is no pushing through the door and it’s not revolving either atleast not in Minnesota. I have seen those that fail at the surgery and they tend to do everything against what they are told.
    This is simple it is a choice one makes as a last resort to all attempts at weight loss I know because that’s how my doctor and I approached this several years of working at losing and maintaining until we found that it was the best course of action for me.
    What about the positive side effects from the surgery that you fail to mention.
    The cured sleep apnea! People who are insulin dependent diabetics suddenly are not needing the insulin anymore! High blood pressure gone! High cholesterol gone! Energy back able to walk run and play with my kids without wanting to sit down every 10 minutes!!!!
    The issues you speak of as negatives I will venture to bet that they come from those who attempted to eat and do things faster than they should of and or didn’t follow their doctors directions.
    I have had no major issues hair loss broken bones constant dumping or any of the others……

  40. Katherine

    I found this article while looking for something else. I was surprised by the tone of the writing, that seemed so hostile to WLS. It reminds me that there are extremely opposite beliefs on almost every subject under the sun. I just wanted to add my personal experience, and there are others like me. For years I was overweight but relatively healthy. Slowly different health problems emerged including diabetes. A rare disease led tho brain injury, then strokes began 3 years later. After 10 years my diabetes progressed from pills to insulin. By my 40th birthday, I began having blood clots and taking blood thinners. More conditions emerged and at 45, my medical team had a serious talk with me – they said I might have another 5 years tho live.

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