choosing a weight loss surgery

JackieOnLine · Mar 5, 2015

this is some quotes from a hello thread with a ton of great info in it but also a lot of it is personal/specific. nothing wrong with that! but for anyone researching WLS, I thought I'd pull some basic bullet points out. (and sorry if I left some smart stuff out, this is just a quickly post on my way to work)

from Diana:

the more you lose, the more your body is going to fight you on further weight loss), the main thing is that you need to do your research before you chose (1) the surgery you need and (2) - in that order - your surgeon.

THINK TWICE, CUT ONCE

from Larra:

Instead of getting easier as you go because of your new habits, dieting and weight loss become harder and harder with time. It's not your fault! You are fighting your metabolism and physiology and your only weapon is your conscious mind. Obesity is very complex, not a matter of calories in/calories out.

if fat people would only adopt lifestyle change...but this ignores everything we are learning about obesity and how complex and multifactorial it is, and how our bodies change with obesity, how they changes are greater the heavier we are and the longer we are obese, and how even with weight loss these changes don't revert back to a normal metabolism. We have learned about hormonal changes that don't go away, that actually get worse when you lose weight without surgery.

from Munchkin:

obesity is a disease. It is not a character flaw. And a disease should be treated. Aggressively!

did you diet yourself up to your present weight? Do/have diets worked for you? Is your metabolism ruined? Can you gain weight on 1000 or so calories a day? Next what do you want your postop life to look like? Do you want to diet forever or do you want to be eating a relatively normal diet? Are you able and willing to do the supplements if necessary? Answer these questions and you will figure out what you need to do.

from Hilary:

95% of obese individuals who attempt weight loss through diet and exercise alone are unsuccessful long term. As someone recently wrote elsewhere on this board, that's why there aren't Biggest Loser Reunion / Where Are They Now shows. The weight loss part is difficult, but feasible. The keeping it off part is near impossible.

if you don't succeed, it won't be because of a lack of willpower, but rather that your body is extremely efficient at absorbing and retaining calories

from Bearmom

a surgeon doesn't send away a paying customer, and only recommends the surgery they happen to do, EVEN IF IT'S NOT BEST FOR THE PATIENT.

from Liz

The reason many sleeves revise to the RNY is that they go to surgeons who do not know HOW to do the DS.

DianaCox · Mar 5, 2015

Here is a rewrite of a post I wrote, genericized, about "fatitudes," in particular regarding the "need" for pre-op diets:

There are several archetypal "fatitudes" - defensive attitudes that fat people adopt to deal with the insults and dismissive attitudes of others towards them, including the presumption that fat people are stupid, lazy, lack self-control, etc. One that we vets are very familiar with is a version of the passive-aggressive one - the MO person is passive to their "caregivers" - acquiescing to what they deign to bestow upon the MO and their "greater knowledge" in the desperate but misguided beliefs that (1) they know what they're talking about and (2) they have the MO's best interests at heart. And the MO submissively buys into their LIES that all they have to do is be less stupid, less lazy, more self-controlled, and prove it by putting themselves on a WORTHLESS, TORTUROUS starvation diet, in order to prove themselves worthy of their further treatment, or (even more outrageously) to demonstrate that they don't need any surgery at all.

But neither of these lies is true. And that is what we vets try to teach the newbies before they get led down the garden path of making a HUGE mistake. But - instead of getting aggressive with the people who are LYING to them, these passive-aggressive MOs sometimes get angry at us for challenging - harshly - their fiercely held beliefs in the lies they are being told by "professionals," for whom the MOs seem to have an unhealthy need to believe have their life in their hands, and best interests at heart.

Of course, their anger is misdirected. We vets are "their people," and not the clueless, heartless "professionals" who don't really know what's best for them. We are not presuming that the MOs are stupid, lazy or lack self-control because they are fat; we are telling them that the reason they are fat in the first place is MEDICAL, and their heroic efforts to try to kowtow to the "professionals" forcing them to prove their worthiness of the gift of an inadequate surgery is utterly misplaced. They don't need to "prove" their worthiness to us - their worthiness for getting a PROPER surgery is their willingness to learn the real reason they are MO, why they are being misled and jerked around by their current medical "team," their willingness to learn and understand why that is, both internally and externally, and their willingness to change their belief system.

Some MO's insistence on what a good boy/girl they can be in controlling their diet is pathetic, painful and sad to us, because we KNOW they will fail - we've all been there, done that. Many many times over. There are kings and queens of deprivation and extreme dieting on our board, and they will ALL tell the MO that they are doomed to fail. Watching them insist they can do this by perseverance is disturbing in the extreme to us - it's like watching a child touch a hot stove, despite being warned not to. By telling the MOs that they are going to fail with their new-found resolve to be the perfect dieter, we are telling them to STOP HURTING THEMSELVES FOR NO REASON, and to stop letting their "team" abuse them as a stupid, lazy pig who lacks self-control, because they are NOT - they have a metabolic disease which no amount of dieting can overcome, much less fix, and there is a treatment that WILL fix it that their current doctors are withholding from them, because the docs are ignorant about the DS, heartless in their lack of concern about the failure rate of what they are offering their patients, and can't make money off of them to offer the DS, because they aren't selling that particular service.

If an MO person wants to persist with their self-defeating fatitude, they may as well go somewhere else, where the people will be only too happy to concur with them that they are stupid, lazy and lacking in self-control, and encourage them to try HARDER to prove themselves when they fail - as they are guaran-damn-teed to do. Why the newbie MOs would want to do this is beyond me, but sadly, as we have learned, some people just HAVE to be the victim - and will go to extreme lengths to prostrate themselves before their abusers to take the punishment they have been brainwashed into believing they deserve. And even more sadly, some of them are so invested in this self-destructive view of themselves, they cannot change their world view, no matter how much information they are given. Hence, the meme about leading a person to knowledge, but not being able to make them think.

This is all well-trod territory for most of us, and we understand it is new to the newbies. But it is frustrating to see how hard they clutch these self-defeating and self-blaming mischaracterizations of the cause of their morbid obesity.

And if it's too much for newbie MOs, I'm sure they can find some pablum-feeding alternate sites to get their (mis)information from. If they can't handle the candor (check the tagline of this board), perhaps that would be better for you than this site. But do NOT expect us to change. We know what works for the people who can handle the truth. The rest are welcome to enjoy their suffering they seem to so desperately crave. If these passive-aggressive MOs were totally honest with themselves, they would see that it is really about their own self-hatred.

"I didn't need to get right with food - food needed to get right with me." I don't diet anymore. I don't hate myself, and I don't feel guilty about what I eat. We want the newbies to think about what that means, as compared to the attitude they currently have about what they need to do and think and feel to conquer their obesity.

JackieOnLine · Mar 5, 2015

the presumption that fat people are stupid, lazy, lack self-control, etc.

anyone who doubts society believes this: you don't have to look any further than a TV show like The Biggest Loser - how much respect are those contestants given? ZERO. they are there to be harassed and humiliated.

our society has a HUGE problem with judging obese people. besides being unfair it can lead to really poor medical care, as people with other issues get dismissed because "they should just eat right and exercise".

DianaCox · Mar 5, 2015

Coincidentally, perhaps, one of classmates on my college class message board, which is HIGHLY politically polarized, made this post, citing an article about research that applies to the post I made above.

A propos of John's comment about the poor reporting reinforcing stupid assertions and conclusions:

I've kept silent about Netanyahu's gratuitous and blatantly political speech in front of the U.S. Congress because it was obvious that everyone who had commented had already made up their respective minds and there was little room for discussion much less debate.

It turns out that feeling of futility may not just be empty pessimism. Now there's research that demonstrates that while people can indeed understand and absorb new objective information that conflicts with their beliefs, these new insights don¹t actually change their opinions.

In other words, people become so emotionally invested in a perspective - even when they acknowledge it's wrong - that they refuse to change their mind.

The cited article: http://www.npr.org/2014/03/04/285580969/when-it-comes-to-vaccines-science-can-run-into-a-brick-wall

When It Comes To Vaccines, Science Can Run Into A Brick Wall
MARCH 04, 2014 5:00 AM ET

SHANKAR VEDANTAM
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Morning Edition

4 min 39 sec

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The public health community has been trying for years to debunk the spurious connection people have been making between vaccines and autism. Have the messages been backfiring?

Copyright © 2014 NPR. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

DAVID GREENE, HOST:

Public health officials in the United States are used to fighting diseases like AIDS, heart disease and cancer. Sometimes they have another enemy to fight: us, or at least our erroneous beliefs. Over the last decade, public health officials have tried to debunk a belief some parents have that vaccinating their children can lead to autism.

NPR social science correspondent Shankar Vedantam came by to talk about some research, suggesting that efforts to spread the word about scientific truths can actually backfire.

SHANKAR VEDANTAM, BYLINE: There's this new work Brendan Nyhan at Dartmouth College. And what's interesting about Nyhan, David, is that he's actually not a medical researcher, but a political scientist. And over the last several years, he's been studying why it's so hard to debunk political myths and conspiracy theories - so theories such as Barack Obama was not born in the United States, or that the 9/11 attacks were an inside job. And so now, along with his coauthors, Jason Reifler, Sean Richey and Gary Freed, Nyhan decided to take a look at the vaccine safety messages that public health officials often use. He found something very interesting.

BRENDAN NYHAN: It's much harder to change people's minds than we might have thought. Giving people corrected information is often ineffective with the people whose minds we'd like to change, and in some cases it actually can make the problem worse.

GREENE: So he's testing out, finding that people just won't change their minds about what they think they know in the public health realm. And what does he mean by this actually might make the problem worse when you try to spread a message?

VEDANTAM: Well, that's the disturbing part of the study, David. It sounds like it's not just the messages as designed, but that they might actually be counterproductive. So Nyhan and his colleagues have conducted a survey of more than 1,700 parents across the United States. They first evaluated the parents about their views on vaccine safety and then they provide the parents with the information about vaccine safety - specifically about the MMR vaccine - this is the vaccine that protects children against measles, mumps and rubella - and what they find is that the message is superficially effective. So parents who hear the message become more likely to think that the vaccine is safe. But - there's a very big but...

NYHAN: Unfortunately, giving people corrected information also made them less likely to say they would vaccinate a future child with MMR vaccine. And that effect was concentrated among those parents with the least favorable vaccine attitudes.

GREENE: Shankar, I'm struggling to make sense of this. I mean you have parents who are believing that the vaccines were safer and those parents are less likely to want to get their kids vaccinated?

VEDANTAM: Well, I think, David, what Nyhan seems to be finding is that when you're confronted by information that you don't like, at a certain level you accept that the information might be true, but it damages your sense of self-esteem. It damages something about your identity. And so what you do is you fight back against the new information. You try and martial other kinds of information that would counter the new information coming in. In the political realm, Nyhan is exploring the possibility that if you boost people's self-esteem before you give them this disconfirming information, it might help them take in the new information because they don't feel as threatened as they might have been otherwise.

GREENE: This is a matter of people not wanting to acknowledge that they may have been wrong about something for many years.

VEDANTAM: That's right. And also that if they were to acknowledge that they have been wrong, it might mean large changes in, not just their behavior, but their sense of who they are and their sense of identity.

GREENE: It's interesting. I mean, this really sounds like a difficult position for public health officials fighting somewhat of an impossible battle. But if it's a matter of improving people's self-esteem before they get information, I mean, are public health officials confident that they can find a specific way to do that?

VEDANTAM: Well, the idea that self-esteem might help in communicating these messages is something that has not yet been tested in the public health domain, David, so it would remain to be empirically validated. I think the big take-away from this study is that it's a really dangerous idea to trust our intuition about these public health messages. It's really important to test them to see whether they work, because our common sense about how effective these messages might be might actually turn out to be wrong.

GREENE: Shankar, it's always good to have you on the program. Thanks a lot.

VEDANTAM: Thanks so much, David.

I'm thinking that this may explain why the Bad Cop/Good Cop works - first I aggravate people and get them mad and insecure but aware of the issues, and then the nice people come behind and restate what I said, but much more nicely, salvaging their self-esteem, and making them more amenable to switching sides.

I hope the advertising agencies for the fast food companies never figure this out!!

DianaCox · Mar 5, 2015

Hmm, and now there is this, which applies very similarly to the "fatitude" that morbid obesity is a moral failure that is the patient's fault (OA, anyone):

http://www.salon.com/2014/03/23/the...ymous_theres_a_better_way_to_treat_addiction/

Alcoholics Anonymous is a part of our nation’s fabric. In the seventy-six years since AA was created, 12-step programs have expanded to include over three hundred different organizations, focusing on such diverse issues as smoking, shoplifting, social phobia, debt, recovery from incest, even vulgarity. All told, more than five million people recite the Serenity Prayer at meetings across the United States every year.

Twelve-step programs hold a privileged place in our culture as well. The legions of “anonymous” members who comprise these groups are helped in their proselytizing mission by TV shows such as “Intervention” (now canceled), which preaches the gospel of recovery. “Going to rehab” is likewise a common refrain in music and film, where it is almost always uncritically presented as the one true hope for beating addiction. AA and rehab have even been codified into our legal system: court-mandated attendance, which began in the late 1980s, is today a staple of drug-crime policy. Every year, our state and federal governments spend over $15 billion on substance-abuse treatment for addicts, the vast majority of which are based on 12-step programs. There is only one problem: these programs almost always fail.

Peer-reviewed studies peg the success rate of AA somewhere between 5 and 10 percent. That is, about one of every fifteen people who enter these programs is able to become and stay sober. In 2006, one of the most prestigious scientific research organizations in the world, the Cochrane Collaboration, conducted a review of the many studies conducted between 1966 and 2005 and reached a stunning conclusion: “No experimental studies unequivocally demonstrated the effectiveness of AA” in treating alcoholism. This group reached the same conclusion about professional AA-oriented treatment (12-step facilitation therapy, or TSF), which is the core of virtually every alcoholism-rehabilitation program in the country.

****

Any substantive conversation about treatment in this country must reckon with the toll levied when a culture encourages one approach to the exclusion of all others, especially when that culture limits the treatment options for suffering people, ignores advances in understanding addiction, and excludes and even shames the great majority of people who fail in the sanctioned approach.