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Patrick Donnelly
10-04-2008, 06:55 PM
http://www.trueresults.com/faq.asp

So, basically, they put an adjustable rubber band around your gut to reduce the amount you can eat, rather than cutting off a large chunk of it. This makes it much more safe than gastric by-pass surgery. I'm not seeing any explicit pricing, but I assume it'd be cheaper too. I'm fairly certain that few people here would call this a good thing, as it just enforces bad eating habits and the "there's always an easy way out" mentality, but for those seriously contemplating gastric bypass, this seems to be a better alternative. The next step is to just get people to no longer need gastric bypass surgery!


On a side note, if I decide to move up to the 105kg weightlifting class (currently in the middle of the 94kg), I'll be "obese" by BMI standards, and qualify for the Lap-Band. Hah.

Steven Low
10-04-2008, 07:34 PM
Yep. Epic phailure.

We need more self control and personal responsibility in the U.S.

Derek Weaver
10-04-2008, 08:13 PM
Yup, Kaiser Permanente's been doing lap bands for a while.

It pisses me off.

My favorite Gastric Bypass Alternative is... eating less and moving more. Works wonders.

Dave Van Skike
10-04-2008, 10:59 PM
super charming to judge from the sidelines and talk about self control. I dare anyone to spend a day with a patient who has a metabolic disorder or better yet a week with someone post lap band surgery. it's a brutal, brutal choice and incredibly ignorant to think any of the choices are an "easy way out".

Judge not, lest some fat kid beat the crap out of you.

Derek Weaver
10-04-2008, 11:38 PM
Good point Dave, though I did date a girl for a long while who was in the process of developing a very severe metabolic disorder and ended up requiring medical and psychiatric intervention, though it was anorexia... opposite end of the spectrum, just as nasty and unhealthy. And you're right, it's not fun, it's a brutal experience for all involved.

My personal problem, is that KP patients who are candidates for the Lap Band are monitored and "forced" to exhibit self control and weight loss of a certain percentage or number of pounds before they can be approved. Why not just push them the whole way to a "healthy" bodyweight?

There are those who have thyroid issues (my uncle is one of them), and other hormonal disorders over which they have zero control, and a Lap Band or Gastric Bypass is a good way of implementing rather severe caloric restriction to help aleviate the weight issue and improve the quality of life. I have zero problem in this case. Certainly a good thing.

For most others though, self control is all that's needed. It's not easy, but it is simple. The sad truth is that we enable in this country, and we have a whole generation of children likely to die before their parents as proof of it.

I'm not trying to be mean, I'm just sad at the state of what's happening with our population.

Chris Forbis
10-05-2008, 06:39 AM
60 Minutes did a piece on gastric bypass that was interesting.

http://www.cbsnews.com/stories/2008/04/17/60minutes/main4023451.shtml

I found it especially interesting that removal of the duodenum makes diabetes (type II, I assume) go away, independent of body weight and stomach removal.

Dave Van Skike
10-05-2008, 10:11 AM
Good point Dave, though I did date a girl for a long while who was in the process of developing a very severe metabolic disorder and ended up requiring medical and psychiatric intervention, though it was anorexia... opposite end of the spectrum, just as nasty and unhealthy. And you're right, it's not fun, it's a brutal experience for all involved.

My personal problem, is that KP patients who are candidates for the Lap Band are monitored and "forced" to exhibit self control and weight loss of a certain percentage or number of pounds before they can be approved. Why not just push them the whole way to a "healthy" bodyweight?

There are those who have thyroid issues (my uncle is one of them), and other hormonal disorders over which they have zero control, and a Lap Band or Gastric Bypass is a good way of implementing rather severe caloric restriction to help aleviate the weight issue and improve the quality of life. I have zero problem in this case. Certainly a good thing.

For most others though, self control is all that's needed. It's not easy, but it is simple. The sad truth is that we enable in this country, and we have a whole generation of children likely to die before their parents as proof of it.

I'm not trying to be mean, I'm just sad at the state of what's happening with our population.


Derek the anorexia tie in is very apt. Anorexia and morbid obesity are not simply metabolic nor purely psychological issues, they're both.

Both are severe addictions, and expecting anyone to suck it up and just quit is dismissive and ignorant...not than anyone here would do that, but there is a prevailing tone among members of any "fitness" arena to take an evangelical approach to these kind of issues.

George Mounce
10-05-2008, 10:57 AM
The number one thing people with any kind of problem need is help. While we may find help to be through changes in habit, unfortunately that may not always be the answer. I won't lie, I think its weak-willed to need something unnatural to change a habit (surgery to change one's stomach). Of course I'm one to talk (and you can all laugh at me) I'm extremely addicted to MMORPG video games. No lie, I'd go on 48-hour playing marathons, which is why I had to quit playing MMORPGs. They were taking over my life.

Funny thing is you don't find many anorexic people in nation's plagued by starvation. So to me its another byproduct (like my lame video game addiction) of something in our "modern" society, fueled by the need of many to feel socially accepted to an extreme.

Philip Stablein
10-05-2008, 04:20 PM
Of course I'm one to talk (and you can all laugh at me) I'm extremely addicted to MMORPG video games. No lie, I'd go on 48-hour playing marathons, which is why I had to quit playing MMORPGs. They were taking over my life.

I won't laugh. I had a few hundred days down the drain before I quit. Fitness is a much better hobby, being self limiting, and having better results from intensity than from volume. Plus the persistent gains you get when working out have a value beyond pixels on a screen or numbers in a database.

But I think the issues of addiction, control, etc are very apt. I think that there will be a few cases of people who are CF addicted. Its got many of the same qualities of an MMORPG or of food: reward, repeatability, community, and having lots to master.

My fiancee wanted to make sure I wasn't repeating the same poor behavior patterns when I first started CFing and particularly with PLing and weight gain. She was worried, and rightly so, that I would simply never stop. Always chasing the next DL number or the next weight class. However, I made SURE when I started CF, that it would be sustainable, healthy, and that I would not spend massive amounts of time researching, reading, practicing. So far so good!

But no matter the arena addiction is hard to break. A relevant question: what proportion of lap band and surgery electees are truly clincally addicted to eating? Or is it simply just a pattern of convenience? I actually don't know enough about morbid obesity, and I oughto learn more, and find out how it differs from what I could term "casual obesity".

Although I admit my own limitations, it seems that Dave's point about the disorder being neither purely metabolic or purely psychological has some face validilty. I just spend Saturday at the Obesity Society (treatment not practice) annual conference, and there was very little about the psychology of food addiction. Mostly just chemical or clinical info sessions, abstracts etc. Lots of bio too. The one presentation I went to about "coaching weight loss" was nice, from the point of view that a lot of clinicians needs to be reminded that weight loss/health arent just about the number on the scale, or the drug regimen or the food log.

On a less serious note, I too will be moving up to the obese weight class this winter! 95 kilos here I come!

note: it seems my spellcheck has crapped out. Sorry :(

Derek Weaver
10-05-2008, 08:10 PM
Derek the anorexia tie in is very apt. Anorexia and morbid obesity are not simply metabolic nor purely psychological issues, they're both.

Both are severe addictions, and expecting anyone to suck it up and just quit is dismissive and ignorant...not than anyone here would do that, but there is a prevailing tone among members of any "fitness" arena to take an evangelical approach to these kind of issues.

As usual Dave you make awesome points. Any addiction is a combination of physical and psychological factors, yet like Philip said, how many people who are morbidly obese have the genetic factor working against them as well?

Many may, but I have a hard time believing that the majority do in fact suffer from addiction. Like I said in my original response, Lap Band candidates for KP are required to go on low carbohydrate, low calorie diets and do periodic check ins for weight loss. Why has nobody stopped and gone "Wait a second, we can all lose the weight without surgery... yet we're still going to have it?" I don't get it.

Don't get me wrong, I don't think it's easy, I think it is a very difficult decision to make. However, I think we live in a society that "thrives" on instant (or near instant) gratification. Lap Bands and Gastric Bypasses offer quicker results than reading literature, signing up for a gym (or not, gyms aren't entirely necessary), and if needed joining a support structure (Weight Watchers). All of that is likely cheaper as well.

Patrick Donnelly
10-05-2008, 08:46 PM
For those who absolutely require some sort of surgery to save their lives, this is great. For those who simply want some sort of surgery to save their lives, this is better, however lamentable their need may be.


I wonder how any sort of volume-restriction surgery works. I remember a study citied in Good Calories, Bad Calories that involved rats eating several times the volume of their typical diet to simply get the same number of calories per day, eating much more diluted foods. Is it simply such an enormous reduction of volume that calories don't matter? What about nutrition? You're practically turning a morbidly obese person into an anorexic one by reducing their meals to just a few ounces each. That hardly seems healthy either.

Re: Derek
I hadn't heard about the testing period beforehand to determine discipline and eligibility. While it would be great if people could maintain the habits that get them through the trial period, I can't help but feel that some people have the discipline solely because they know they are being tested. As another example, take Alli. Taking the pill reduces your dietary fat intake by about 3/4's... Of that, 1/4 is the pill, and the other 1/2 is your own food choices. If people want to loose more weight, why don't they just cut the calories themselves without the pill? (Assuming low-fat diets lead to weight loss.) Because the pill offers the extra "incentive" to help keep you strictly on the diet.

Re: Chris
Good article. However, if the duodenum is supposedly partially responsible for diabetes, cancer, etc. why hasn't human evolution changed the way the digestive tract works?

Funny thing is you don't find many anorexic people in nation's plagued by starvation. So to me its another byproduct (like my lame video game addiction) of something in our "modern" society, fueled by the need of many to feel socially accepted to an extreme.

Interesting point.

Re: Phil
94kg is the top of the class, so you may want to avoid hitting 95.

Steven Low
10-05-2008, 09:49 PM
If morbid obesity is on the same level as anorexia or other similar conditions (aka both metabolic and psychological like you guys are saying) then riddle me this: why isn't it treated the same way? If someone admits they have anorexia or bulemia they would definitely be strongly encouraged to meet with a psychiatrist and a dietecian to make sure they aren't starving/harming themselves. Why not the same with the obese?

I mean, cost is definitely a factor along with some others... But can't people see they're ruining their lives (or at least shortening them and putting themselves at risk for tons of other diseases)? Shrug.

Yes, I can be insensitive at times (well, a lot of the time - working on it), but seriously.. obesity is one of the largest drains on healthcare, and it IS preventable. It is a HUGE problem especially here in the US and other first world countries. We need solutions. If you don't like the self control/personal responsibility option (which I do think can/should work in at least SOME cases) might I suggest coming up with a different one instead of just handily criticizing it as being insensitive or rude?


Good article. However, if the duodenum is supposedly partially responsible for diabetes, cancer, etc. why hasn't human evolution changed the way the digestive tract works?

Uh, cause excessive food abundance has only really been around for the past say 50 or so years (maybe 100 if you wanted to be conservative)... I think that should cover it.

Blair Lowe
10-05-2008, 10:15 PM
My friend and roomate mom's just went through a gastric bypass. I don't know what her medical care company is but she had to go through a period of losing 50-60 pounds before she could get the surgery. I think this was to increase the odds of her not having any problem on the table but also put her on the road to eating better.

At first she wasn't happy about it. As well, she went on splenda, just as her two sons did ( my roomates, one of which is morbidly obese and the other overweight fat [ though he's lost some excess fluid and weight due to biking with no change in diet for him or his bro]).

I was given some weird looks when I said, " you lost that much weight on your own, why not keep going without the surgery. " As far as I know, she doesn't exercise either.

My roomate researched lap band a bit, and it turns out it is a safer surgery and was about 2/3rds of the cost between 10 and 15k maybe 12k.

Seeing my friends who are very into MMORPG has kept me away from them. I have played them my share, but sparingly because I tended to just have other interests and was always wary of something that would control my time ( I'm a control freak ).

Dave Van Skike
10-06-2008, 12:02 AM
If morbid obesity is on the same level as anorexia or other similar conditions (aka both metabolic and psychological like you guys are saying) then riddle me this: why isn't it treated the same way? If someone admits they have anorexia or bulemia they would definitely be strongly encouraged to meet with a psychiatrist and a dietecian to make sure they aren't starving/harming themselves. Why not the same with the obese?


good question, Steven. The medical community may be missing the boat on this one.. I believe most of these types of disorders should start with a psychologist.

But here's a better question, if it's just so damn easy and a matter of willpower, how is it that so many people, stay morbidly or even mildly obese? they like it?, they're stupid? they're just weak? I mean, it's just calories in calories out right?

Yes, I am criticizing the rampant ignorance and stupidity of both ends of the spectrum, skinny bootstrappers who think it's just so simple and the Medical industry that is earnestly engineering invasive solutions.

I suggest fix what is broken. Someone who is on the verge of needing lap band surgery has serious psychological problems. Period. If you have spent any time around a victim of anorexia or a morbidly obese person, you'd note that the similarities are chilling.

Sorry if I come off as overly strident but the judgmental BS is a just a shade thick up in here and there is abundance of talking out of ass syndrome.

George Mounce
10-06-2008, 05:00 AM
As far as the duodenum procedure (which is another form of gastric bypass), it only then masks the problem (incorrect eating) and causes more down the road for those who get it done according to my mother who is a diabetic (Type I), diabetic educator and RNP. It isn't a fix by any means, its another lazy person's way out of bad food choices. My mother is against the procedure and would rather change someone's eating habits and educate them, than go for a permanent body-altering surgery.

I also agree with Steven - we don't cut things out of anorexics to make them better do we? Obese people need help with their head, not their small intestine.

Garrett Smith
10-06-2008, 09:56 AM
Messing with the digestive system = bad idea.

One patient I saw recently had violent bouts of dumping syndrome (http://en.wikipedia.org/wiki/Gastric_dumping_syndrome) very soon after eating her meal. This was after having her gall bladder removed several decades ago--thing is, she started gaining weight right after that surgery--now she is 5'2" 260#. Last I heard, the digestive aid/enzyme formula I Rx'd her had already fixed most of the dumping issue and she was dropping weight (I gave NO dietary advice, she wasn't interested).

Another person, who I haven't seen yet, is a friend of the above person. She has a Lap-Band. I was told she is dealing with constantly vomiting up her food. Obviously a tightened ring around the top of the stomach can backfire--pun intended...

Self-control is not a natural instinct, it must be trained. We are simply wired for feast or famine. Put simply, just as modern medicine has yet to "cure" any disease that isn't nutritional in nature, the "cure" for obesity will never come from surgery. All surgery will do is set up the person for malnutrition in the future.

sarena kopciel
10-06-2008, 10:17 AM
Messing with the digestive system = bad idea.



Self-control is not a natural instinct, it must be trained. We are simply wired for feast or famine. Put simply, just as modern medicine has yet to "cure" any disease that isn't nutritional in nature, the "cure" for obesity will never come from surgery. All surgery will do is set up the person for malnutrition in the future.


How true, but people today really just want a quick fix--not long term change. Who thinks down the line.....

Craig Loizides
10-06-2008, 12:52 PM
I hadn't heard about the testing period beforehand to determine discipline and eligibility. While it would be great if people could maintain the habits that get them through the trial period, I can't help but feel that some people have the discipline solely because they know they are being tested. As another example, take Alli. Taking the pill reduces your dietary fat intake by about 3/4's... Of that, 1/4 is the pill, and the other 1/2 is your own food choices. If people want to loose more weight, why don't they just cut the calories themselves without the pill? (Assuming low-fat diets lead to weight loss.) Because the pill offers the extra "incentive" to help keep you strictly on the diet.

I've always thought the best way to get people to lose weight would be to sell them placebo pills for $100 a month and tell them it's guaranteed to work as long as they also eat well and exercise. Anybody want in on this with me?

Good article. However, if the duodenum is supposedly partially responsible for diabetes, cancer, etc. why hasn't human evolution changed the way the digestive tract works?

The duodenum isn't responsible for diabetes, it's responsible for digestion. Digest too much of the wrong foods and you get diabetes. At least that's my interpretation of it.

But here's a better question, if it's just so damn easy and a matter of willpower, how is it that so many people, stay morbidly or even mildly obese? they like it?, they're stupid? they're just weak? I mean, it's just calories in calories out right?

Good Calories, Bad Calories has a lot of interesting ideas on this. Taubes basically argues though that too much emphasis is made on the psychological and will power aspects and too little on hormonal and metabolic causes.

Derek Weaver
10-06-2008, 06:18 PM
good question, Steven. The medical community may be missing the boat on this one.. I believe most of these types of disorders should start with a psychologist.

But here's a better question, if it's just so damn easy and a matter of willpower, how is it that so many people, stay morbidly or even mildly obese? they like it?, they're stupid? they're just weak? I mean, it's just calories in calories out right?

Yes, I am criticizing the rampant ignorance and stupidity of both ends of the spectrum, skinny bootstrappers who think it's just so simple and the Medical industry that is earnestly engineering invasive solutions.

I suggest fix what is broken. Someone who is on the verge of needing lap band surgery has serious psychological problems. Period. If you have spent any time around a victim of anorexia or a morbidly obese person, you'd note that the similarities are chilling.

Sorry if I come off as overly strident but the judgmental BS is a just a shade thick up in here and there is abundance of talking out of ass syndrome.

Fix what is broken? That only happens in systems where the point is for people to get legitimately better, our health care professionals tend to just look after the appearance of better.

I like your idea of required psychological analysis prior to invasive procedures.

In the end, just like Patrick pointed out with Alli, and Craig said with his placebo idea (I think you've stumbled onto a goldmine my friend) it is a matter of the mind. Whether is psychological addiction or a matter of having will power and discipline is an individual basis. I still feel like more people just don't care than don't have control, if they did, they would do something about it before they got to a point where surgery became a viable alternative.

Patrick Donnelly
10-07-2008, 09:56 AM
As far as the duodenum procedure (which is another form of gastric bypass), it only then masks the problem (incorrect eating) and causes more down the road for those who get it done...
What kind of side effects are these? The article from before only mentioned the numerous benefits, with no mention of negative consequences (not surprisingly).

But here's a better question, if it's just so damn easy and a matter of willpower, how is it that so many people, stay morbidly or even mildly obese? they like it?, they're stupid? they're just weak? I mean, it's just calories in calories out right?
From my experiences with obese family, it's a combination of them liking the food that causes it (not everyone thinks strawberries taste better than cake), misinformation (low-fat Yoplait, 100 calorie packs of junk food...), and then discouragement from failing so many times before.

I still feel like more people just don't care than don't have control, if they did, they would do something about it before they got to a point where surgery became a viable alternative.
I am now considering the possibility that they just don't think they have the will power. If you had told me a few years ago that I would soon be eating, exercising, and living the way I do now, I would have thought you were f'ing crazy. Additionally, encouragement for the obese to loose weight from those who have already become healthy is ineffective and only further discouraging because those who are healthy are seen as "miracles."

I've always thought the best way to get people to lose weight would be to sell them placebo pills for $100 a month and tell them it's guaranteed to work as long as they also eat well and exercise. Anybody want in on this with me?
Aren't placebos typically sugar-pills? The logistics may need a bit of ironing out, but count me in. Haha.

George Mounce
10-07-2008, 11:17 AM
Not side effects. People who get this done have no control over their eating habits - they still eat the shit that got them there. Its a quick fix.

It manages the diabetes, it doesn't cure it. It changes how your body manages it's chemistry, how it digests foods...etc. Its not natural.

Off the top of my mother's head, it also increases calcium and potassium loss. From one patient she has worked with who had the procedure, the patient experienced the standard weight loss because of the smaller meal intake (which at first is all liquid meals), which can lead to vomiting and rip the sutures. Biggest problem this person had was a huge drop in potassium levels and ended up back in the hospital with cardiac issues due to potassium loss.

With the weight loss, my mother explains that not all the insurance companies will cover the removal of excess skin, which can cause some mental anguish.

Ok, my mom just gave me her log on to MedScape Nurses (free to join), here is some abstract info:

The Long-term Effects of Gastric Bypass on Vitamin D Metabolism

Posted 05/11/2006

Jason M. Johnson, DO; James W. Maher, MD; Eric J. DeMaria, MD; Robert W. Downs, MD; Luke G. Wolfe, BS; John M. Kellum, MD

Abstract

Objective: Alterations of the endocrine system in patients following Roux-en-Y gastric bypass (GBP) are poorly described and have prompted us to perform a longitudinal study of the effects of GBP on serum calcium, 25-hydroxy-vitamin-D (vitamin D), and parathyroid hormone (PTH).
Methods: Prospectively collected data were compiled to determine how GBP affects serum calcium, vitamin D, and PTH. Student t test, Fisher exact test, or linear regression was used to determine significance.
Results: Calcium, vitamin D, and PTH levels were drawn on 243 patients following GBP. Forty-one patients had long-limb bypass (LL-GBP), Roux >100 cm, and 202 had short-limb bypass (SL-GBP), Roux ≤100 cm. The mean (±SD) postoperative follow-up time was significantly longer in the LL-GBP group (5.7 ± 2.5 years) than the SL-GBP group (3.1 ± 3.6 years, P < 0.0001). When corrected for albumin levels, mean calcium was 9.3 mg/dL (range, 8.5–10.8 mg/dL), and no difference existed between LL-GBP and SL-GBP patients. For patients with low vitamin D levels (<8.9 ng/mL), 88.9% had elevated PTH (>65 pg/mL) and 58.0% of patients with normal vitamin D levels (≥8.9 ng/mL) had elevated PTH (P < 0.0001). In individuals with vitamin D levels <30 ng/mL, 55.1% (n = 103) had elevated PTH, and of those with vitamin D levels ≥30 ng/mL 28.5% (n = 16) had elevated PTH (P = 0.0007). Mean vitamin D levels were lower in patients who had undergone LL-GBP as opposed to those with SL-GBP, 16.8 ± 10.8 ng/mL versus 22.7 ± 11.1 ng/mL (P = 0.0022), and PTH was significantly higher in patients who had a LL-GBP (113.5 ± 88.0 pg/mL versus 74.5 ± 52.7 pg/mL, P = 0.0002). There was a linear decrease in vitamin D (P = 0.005) coupled with a linear increase in PTH (P < 0.0001) the longer patients were followed after GBP. Alkaline phosphatase levels were elevated in 40.3% of patients and correlated with PTH levels.
Conclusion: Vitamin D deficiency and elevated PTH are common following GBP and progress over time. There is a significant incidence of secondary hyperparathyroidism in short-limb GBP patients, even those with vitamin D levels ≥30 ng/mL, suggesting selective Ca2+ malabsorption. Thus, calcium malabsorption is inherent to gastric bypass. Careful calcium and vitamin D supplementation and long-term screening are necessary to prevent deficiencies and the sequelae of secondary hyperparathyroidism.

Introduction

The prevalence of obesity ≥ doubled between 1976 and 1999 in the United States.[1] A record number of morbidly obese patients are seeking surgery in an attempt to decrease their weight and ultimately prevent or decrease comorbid conditions associated with their obesity. A number of different weight reduction operations are performed throughout the world, but Roux-en-Y gastric bypass (GBP) is the leading weight reduction operation offered in the United States. It has been well documented that GBP provides long-term weight reduction with prevention or resolution of comorbid conditions,[2-4] [B]but the endocrine side effects of GBP remain incompletely studied.

Until recently, our bariatric surgery protocol included annual screening of calcium, phosphorus, magnesium, and albumin after GBP. With newer literature,[5] suggesting that patients who undergo GBP are at increased risk for vitamin D deficiency, our screening was updated to include both 25-hydroxyvitamin D (vitamin D) and parathyroid hormone (PTH) levels. This is a longitudinal study of prospectively collected data that evaluates the endocrine effects of GBP on vitamin D, calcium and PTH levels.

If you want more, let me know, I now have access to thousands of pages of this stuff.

Garrett Smith
10-07-2008, 12:24 PM
Most of the time, surgical manipulation of the GI system results in malnutrition, unless specifically addressed through food choices and most often, supplementation.

First thing we are taught in naturopathic medical school is that "when in doubt, treat the gut". These folks will always be behind the 8-ball in that respect (as in, they are missing parts that G-d intended to be there, so things likely won't work right ever again).