Commentators like to opine that we are a “thinness-obsessed society.” They couldn’t be more wrong. A short walk down almost any crowded street in America will reveal the truth: we are a fatness-obsessed society. Americans are fatter than any other major nation in the world, now or at any other time in history.
We are simultaneously repelled and fascinated by the subject of obesity. Not too long ago, the British television program Body Shock showed rescue workers trying to flip over 1,072-lb Patrick Deuel in bed. As he lay there like some freakish-looking giant turtle that had been upended, viewers could see that his underside was flat, like a pancake, having conformed to the shape of the bed on which he had been lying face-down for the past seven years.
What makes people fat? Unless someone has found a way around the First Law of Thermodynamics, the only way to gain weight is to take in more calories than you burn. And the only way to lose weight is to burn more calories than you take in, which means to exercise and eat less. And, as long as there are people who will do anything to lose weight besides exercise and eat less, there will always be a market for weight-loss scams.
Weight loss surgery is big business. In 2006, over 177,000 such operations were performed in the United States alone. A study by the Pennsylvania Health Care Cost Containment Council looked at all bariatric surgeries performed in Pennsylvania in the year 2003 and found that the average cost for surgery and six months of follow-up care was $35, 643. That’s over $40,000 in today’s dollars.
Does the surgery really do anyone any good? Try googling “weight loss surgery side effects” and you will find enough hair-raising and stomach-turning anecdotes to satisfy the most morbid curiosity – click here for a recent example. Here's another. But anecdotes are not data.
Trying to find reliable data on the long-term effects of weight loss surgery is a task akin to trying to flip over Patrick Deuel in his bed. Many of the physicians performing and reviewing these studies are on the payrolls of the medical supply companies. (The medical journals long ago dropped the requirement that authors and reviewers be free of conflicts of interest). Many studies report only short-term outcomes, even though the effects of this surgery last an entire lifetime. Most bariatric surgery patients report dramatic losses for the first year or two, but many end up gaining most or all of that weight back. Some even end up weighing more than they did before the surgery.
I know of only one controlled clinical trial that measured long-term weight loss after bariatric surgery. Odd, given that the whole point of the surgery is weight loss, and the effects of the surgery last a lifetime.
The Swedish Obese Subjects Study assessed both weight loss and mortality in a group of 4,047 obese individuals. Approximately half of these individuals underwent various types of weight loss surgeries, and the other half underwent “conventional treatment” (which, the paper cheerfully explained, sometimes meant “no treatment whatsoever”). Subjects were monitored for an average of 10.9 years apiece after enrolling in the study.
After ten years, subjects in the control group lost essentially no weight. Those who had the lap-band lost an average of 14% of total body weight. That means that someone who weighed 300 pounds before the surgery would end up weighing 258. Someone who weighed 400 pounds would end up weighing 344, etc. Those who underwent the gastric bypass lost an average of 25% of their total body weight. But of course, the side effects of this type of operation tend to be more severe.
Were they any healthier? The study reports that the subjects who had bariatric surgery had a one in one-thousand less chance of dying in any given year after the surgery compared to those in the control group. Over ten years, this comes out to a one percent reduction in absolute risk.
Other studies have reported much more dismal results in terms of mortality. A study published in JAMA evaluated the risk of death for all Medicare patients undergoing bariatric surgery in the years 1997-2002 inclusive. Most of these patients were between 35 and 54 years of age. The one-year mortality rate was 4.6%, or approximately one out of every 22 individuals. There is no other type of elective surgery that has anything like this sort of death toll. All for a surgery which, for the most part, takes obese people and renders them somewhat less obese.
So is weight-loss surgery the solution? If you think about it for a moment, it should be obvious that it couldn’t be. According to this article in JAMA, sixteen million people in this country are considered eligible for weight-loss surgery. At a cost of approximately $40,000 apiece, the bill would come to well over six hundred billion dollars. Assuming a 4.6% rate of mortality for the first year after surgery, that would mean over seven hundred thousand deaths.
Before we go any farther down this road, maybe we ought to step back and take a look at where we are going. We live in a society in which cutting open a woman’s abdominal cavity and rerouting her intestines is considered "normal," and the idea of expecting an individual to exercise a modicum of self-control is considered, well, crazy. What has happened to us?
Photo via Wikimedia Commons