New York Times article about WLS

[Lucy 0]

This article in today's New York Times pissed me off and I thought others here might be interested in reading another skinny man's inexperienced opinion against WLS:

The Stomach-Surgery Conundrum

By STEPHEN J. DUBNER and STEVEN D. LEVITT

Bariatric Surgery

Deborah Kattler Kupetz is a Los Angeles businesswoman and mother of three who tries to watch her weight. That’s why she recently bought two lifelike plastic models of human body fat from a medical-supply company, a one-pound blob and a five-pound blob, and put them on display in her kitchen.

By doing so, Kattler Kupetz wouldn’t seem to have much in common with Han Xin, a legendary Chinese general who lived more than 2,000 years ago. But she does.

Upon entering one battle, Han assembled his soldiers with their backs to a river so that retreat was not an option. With no choice but to attack the enemy head-on, Han’s men did just that.

This is what economists call a commitment device — a means with which to lock yourself into a course of action that you might not otherwise choose but that produces a desired result. While not as severe as Han’s strategy, Kattler Kupetz’s purchase of those fat blobs was a commitment device, too: every mealtime, they force her to envision what a few extra pounds of fat looks like.

It is hard to think of anyone who employs commitment devices as avidly as the overweight American. Perhaps you once bought a yearlong gym membership or had a three-month supply of healthful meals delivered to your doorstep. Maybe you joined friends in a group diet or even taped your refrigerator shut. The popular new weight-loss pill Alli, which partly blocks the body’s absorption of fat, is a commitment device with real consequences: a person who takes Alli and then eats too much fatty food may experience a bout of oily diarrhea.

So how are all these commitment devices working? Not very well. According to the Centers for Disease Control, one out of every three American adults is obese. Which is why so many people have begun to embrace a far more drastic commitment device, one that Han Xin himself would probably applaud: surgery. This year, more than 200,000 weight-loss, or bariatric, operations will be performed in the United States, a nearly ten-fold increase in just a decade. The most prominent types are gastric bypass and laparoscopic adjustable gastric banding (or “Lap-Band”), although there are a few others. Each one works a bit differently, but the general aim is to reduce the stomach’s capacity and thereby thwart the appetite. If all goes well, bariatric surgery leads to substantial weight loss, especially among the morbidly obese.

Marc Bessler, director of the Center for Obesity Surgery at New York-Presbyterian/Columbia University Medical Center, is an innovator in the field who personally performs about 200 bariatric operations a year. Because his own father was morbidly obese, Bessler brings a personal zeal to his work. “The whole time I was growing up, he was so overweight he couldn’t play ball with us,” he says. “He died at age 54 from colon cancer. It may have been picked up late because of his obesity.”

Bessler acknowledges that bariatric surgery has a checkered history. “In the past, it killed people, and it didn’t work,” he says. “In the late 1950s and early 1960s, even though it was effective for weight loss, there was lots of complications and mortality. Then in the late ’70s and early ’80s, there were much better surgeries, but they didn’t really work that well. The weight would start coming back.”

Technological innovations, especially the use of laparoscopic procedures, have made for considerable gains in safety and efficacy. While the operation is still dangerous in some circumstances — one study found that for a surgeon’s first 19 bariatric operations, patients were nearly five times as likely to die than patients that the surgeon later operated on — the overall mortality rate is now in the neighborhood of 1 percent.

But even if bariatric surgery doesn’t kill you, there are things to worry about. The operation often produces complications — physiological ones, to be sure, but also perhaps psychological ones. A significant fraction of postbariatric patients acquire new addictions like gambling, smoking, compulsive shopping or alcoholism once they are no longer addicted to eating. In certain cases, some people also learn to outfox the procedure by taking in calories in liquid form (drinking chocolate Syrup straight from the can, for instance) or simply drinking and eating at the same time. Surgery is also a lot more expensive than even the most lavish diet, with a Lap-Band procedure costing about $20,000 and a gastric bypass about $30,000.

But Bessler and other bariatric advocates argue that the upsides outweigh the downsides, especially for a morbidly obese patient whose quality of life is already suffering. While asking a bariatric surgeon if bariatric surgery is a good idea might seem akin to asking a barber if you need a haircut — in fact, Bessler does consult for companies in the industry — the data seem to back up his claims: not only do most patients keep off a significant amount of weight but the other medical problems that accompany obesity are also often assuaged. One recent analysis found that 77 percent of bariatric-surgery patients with Type 2 diabetes experienced “complete resolution” of their diabetes after the procedure; the surgery also helps eliminate hypertension and sleep apnea. From an economic standpoint, research suggests that the operation can pay for itself within a few years because a postbariatric patient now requires less medical care and fewer prescriptions. That’s why some insurance companies cover bariatric surgery — as more do, it will likely lead to a further spike in the volume of operations. This is especially good news for the hospitals that have already grown dependent on the significant cash flow that bariatric surgery generates.

There are at least two ways to think about the rise in bariatric surgery. On the one hand, isn’t it terrific that technology has once again solved a perplexing human problem? Now people can eat all they want for years and years and then, at the hands of a talented surgeon, suddenly bid farewell to all their fat. There are risks and expenses of course, but still, isn’t this what progress is all about?

On the other hand, why is such a drastic measure called for? It’s one thing to spend billions of dollars on a disease for which the cause and cure are a mystery. But that’s not the case here. Even those who argue that obesity has a strong genetic component must acknowledge, as Bessler does, that “the amount of obesity has skyrocketed in the past 30 years, but our genetic makeup certainly hasn’t changed in that time.”

So the cause is, essentially, that people eat too much; and the cure is, essentially, to eat less. But bariatric surgery seems to fit in nicely with the tenor of our times. Consider, for instance, the game shows we watch. The old model was “Jeopardy!,” which required a player to beat her opponents to the buzzer and then pluck just the right sliver of trivial knowledge from her vast cerebral storage network. The current model is “Deal or No Deal,” which requires no talent whatsoever beyond the ability to randomly pick a number on a briefcase.

Maybe the problem is that despite all the diets and exercise regimes and gimmicks that have been put into play during our national bout of obesity, the right nonsurgical solution simply hasn’t yet been found. So here’s a suggestion: Hang around your neck a small Ziploc bag containing a towelette infused with an aroma of, well, of something deeply disgusting. (In the interest of not offending anyone who happens to be reading this over Breakfast, we won’t offer specific suggestions, but you can surely conjure a horrid odor on your own.) Every time you’re about to open the refrigerator or look over a menu, unzip the bag and take a whiff. Now that’s a commitment device.

Stephen J. Dubner and Steven D. Levitt are the authors of “Freakonomics.” More information on the research behind this column is online at Freakonomics - Opinion - New York Times Blog.

[jfran 0]

This man obviously has never had a weight problem.

[hollyberries 2]

Ditto...Jfran. What planet is he living on? At least, we admit we have a problem and try to fix it. If we could just hang a bag around our neck with the disgusting smell in it we would not have had surgery to accomplish our goal. What an idiot.

[Boo Boo Kitty 3]

This was the most riduculas thing I have ever read. I have been searching to find an address to write him. Anyone have any ideas?

[Lucy 0]

This is his email address:

levittdubner@freakonomics.com

I fully intend to write a letter to the New York Times. I will post it here when I do.

[musicalmomma 1]

I was OK with the article until the final three paragraphs...I was reading along, thinking to myself...what's wrong with this???? Then he trivialized and minimized our battle and chaulked it all up to "eat less and lose weight" DUH! What an asswipe!

hmmm, I wonder if he can overcome his porn addiction, buy hanging a picture of a wrinkly old granny around his neck and look at that every time he has the urge to hit lolita.com!?!?!?!?!

Again...I reiterate...what an asswipe!

[ivyrose325 0]

"There are at least two ways to think about the rise in bariatric surgery. On the one hand, isn’t it terrific that technology has once again solved a perplexing human problem? Now people can eat all they want for years and years and then, at the hands of a talented surgeon, suddenly bid farewell to all their fat."<O:p</O:p

<O:p

This particular paragraph peeved me the most! I am sure that we can all attest that bariatric surgery is a tool. None of us “suddenly bid farewell” to our fat, it takes a combination of exercise, smaller portions and better food choices to see significant weight loss. Earlier in the article the authors stated “In certain cases, some people also learn to outfox the procedure by taking in calories in liquid form (drinking chocolate Syrup straight from the can, for instance) or simply drinking and eating at the same time.” By the authors’ own admission the successful bariatric patient needs to change dietary habits and behaviors, since the procedure itself is not enough to guarantee weight loss. In my opinion these individuals have not only proved their ignorance about the challenges of being obese, by suggesting that simple aversion therapy would work, but they can’t even formulate and support an argument ! <O:p

[lindata 1]

You know, if you have an address for these guys, we could send them a present of dog poop and THEY could then get a wiff of it. Seriously, I saw this. People sell various sizes of poop and will send it in a baggie (and boxed) with various messages attached. What an A-hole. So they acknowledge that gambling, alcoholism, smoking, compulsive shopping are addictions, but overeating is not? Aren't journalists supposed to actually do a bit of legwork, a bit of investigation before they mouth off personal opinions not even based on fact?

Stephen and Steven, sounds like a couple of winners to me - NOT.

[Boo Boo Kitty 3]

I would like to comment on your NY Times Article “The Stomach Surgery Conundrum” and the blatant level of arrogance and ignorance you have achieved. First let me be the first to congratulate you on such a feat! <?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p>

<o:p></o:p>

I am a Lap Band patient and I am not only completely offended, but amazed by you! It must be that neither of you have never been overweight, nor this subject would have been tackled with more tact (Not that you used any what so ever to begin with) and knowledge. If you had done more research, or even used a bit of common sense you would know that WLS is not an easy decision, nor an easy process! <o:p></o:p>

<o:p></o:p>

WLS is for most of us a last resort for an addiction, that addiction is food. We have a major disadvantage, we need food to live, and we can not just cut it out like a drug addict! Many of us have struggled with weight so long and become so morbidly obese there is no other option, because being a mother of two young children, for me death was NOT an option! I find your thoughts that we should just hang something gross around us not only rude, pig headed but at a new level of disgusting! Cheers to you for making more people ashamed of a surgery that saved their life! You should be very proud for breaking the sprits of so many that have come so far, and those who may not make the right choice because of you! <o:p></o:p>

<o:p></o:p>

I have no doubt you are one of those people who treat fat people with utter disrespect, one that shuts doors in their face, avoids eye contact and other uncalled for behavior. I want to let you know, I am one that you will not break, I am proud. I also want you to know that when my book comes out you will be the first one to receive an autographed copy. May I have your addresses please? I would love you to read it and now how hard a life is overweight and how hard it is to make a decision to change your life. I also want to thank you for confirming that I need to finish my book to not only help others, but to educate idiots like you. Again, thank you!<o:p></o:p>

<o:p></o:p>

Sincerely,<o:p></o:p>

Brandy Chase<o:p></o:p>

<o:p></o:p>

Lap band patient and former fat chick <o:p></o:p>

<o:p></o:p>

[Boo Boo Kitty 3]

Thanks Lucy, that is a copy of the letter I sent to them. It was much shorter than I wanted but I wanted to make sure it got read. I asked for an address, to help us all out! lol...

:scared:

[Lucy 0]

This is the email I sent to the New York Times:

Dear NYTimes,

Steven Levitt and Steven Dubner clearly underestimate the grips of food addiction. By minimizing the struggle of obesity they are only contributing to the stereotype that the morbidly obese are simply lazy or lack self-control. Although there has been an increase in obesity over the past 30 years, they fail to differentiate between occasional gluttons and morbidly obese addicts. In the same way that occasional over-drinkers do not need rehab, occasional over-eaters do not require bariatric surgery. It is clear that for most of its recipients, the benefits of bariatric surgery far outweigh the detriments. Although their article suggests that many patients go on to acquire other addictions or "guzzle chocolate syrup", most understand that this is a last resort and accept the fact that this is a tool to aid in changing their bad habits, a new lease on life that they might otherwise not have been so lucky to receive. Those who have bariatric surgery are taking a difficult and often frightening step to improve their health; how dare Levitt and Dubner be so callous and obtuse as to suggest that a foul odor hung around the neck could break such a crippling addiction.

[Pattypoo1 0]

I hope that if I develop a gambling addiction, that at least I will be successful at that!

[juliegeraci 7]

What an idiot is all I can say. I love my lapband!

[lindata 1]

Yeah Lucy and Brandy!!

[sherilynn 1]

My mouth is still hanging opened, after just having read this. I'm in shock. But most of all I pity the authors.

...can't wait for a few of our heavy hitters to pitch in on this.

BUMP!!!!!!!!!!!