Episode 201 Transcript

You're listening to the Fierce Fatty Podcast. I am your host Vinny Welsby. Pronouns they/them. Episode 201: The Truth About Weight Loss Surgery: Does It Really Make You Thin and Healthy? Let's do it.

Welcome to the show. I missed you. I've been away from my cup for a couple of months. I don't know if you noticed, though I did leave you with a two for one. I left you with a two episodes in one for the last podcast, which was on GLP Ones. There's a reason I've been away. If you don't want to know about my personal life and you don't want to get into the juiciness of weight loss surgery and the stats and all of that stuff, then skip ahead five minutes. If you're nosy and you want to know about stuff about my personal life, then hang out with me. So I have been banana, banana, bananas busy, because there's been a big change in my life, which is I have started university doing a master's degree in counseling, which is so weird. So weird. The reason why I say it's weird is because I was always said in my brain, I would never go back to university. Then about six months ago, maybe longer, yeah, probably longer. I started to take probably a year maybe, who knows? Anyway, I started taking ADHD meds. It has been so transformative for me. My brain, the dopamine that I'm able to access. Honestly, it's been so good for me. That happened. And then the other thing that happened is that I moved into 2025, everything was so busy, so much so busy, I had so much lined up. And then obviously Donald Trump came into office and unfortunately a lot of my clients are in the US consulting clients. So I do training on fat stuff, right? This year has been so difficult. Two reasons, clients are being fired, their DEI area, what I'm trying to say, DEI vertical within their businesses is being defunded. And on the other side of it is the people who are, that's not their situation in the US, they are rightly so supporting and focusing on supporting groups who are in dire need at the moment. So trans people, immigrants, racialized people, et cetera, which is great. But that means that my business has been really tough this year. So with that were the ADHD meds and my very, very, very bestie friend, some In-N-In friend of the show, she is just completing the same thing, same program, same university, and me just following her. She's a guinea pig, does she like it? I've always wanted to be a therapist. But honestly, this doing this stuff, this work here is my dream job. I've always wanted to be a therapist, but I always thought there's some barrier in my brain. The barrier in my brain was that I was not medicated correctly. My ADHD was not being medicated. And anyway, so I got into university, I did 39 days straight of studying to pass two exams because my bachelor's degree is in illustration, to do, to get in and all sorts of other things. Your boy over here got two A pluses in the prerequisite exams courses and having to deal on all the other grades for A pluses apart from a couple of As. I know, I can't believe it turns out that I'm smart. Yeah, so I started university this month. So it's been a bit of a whirlwind of two months of so much work. And now today, I'm able to now get in another podcast for you. That was on my top of my list. I need to get you this stuff. I don't make it easy for myself. The last time we did a podcast, it was a huge deep dive into GLPs. This one, what do I decide to do? A huge deep dive into weight loss surgery. And so this is going to be another two-parter. And with all that, with that all in mind, if you want to show your support for the show, you can donate to me one-time donation or ongoing donation on Ko-fi, K-O-F-I or Ko-fi or however the fuck you say it. Link will be in the show notes, but you don't have to. You can always just, think good thoughts about me or not. I fucking hate you, Vinnie. I'm not going to think good thoughts about you. So much work has gone into this. Honestly. I'm like, why is it there's so many sources. We've got, because there's so many sources for this episode, I have created two separate documents, like an Excel, Google Sheets, and then another doc was summary. And we've got some main book sources, which are the fat studies reader, anti-diet book, the Hayes book, fat activism by Dr. Charlotte Cooper. You just need to lose way, Aubrey Gordon. We've got approximately 40 studies and at least 10 other resources. So it is a jam packed. And then after this, I'm going to make a Instagram post with all of this in one, you know, in a visual so you can share it. But we're going into the studies and the actual data and no, no, but it's a lot and it's like juicy stuff. And if you want to hear some other podcasts about weight loss surgery, this is actually my fifth podcast on weight loss surgery. The the, the first one I did was in 2021. It's episode 90. Some people can't even access it anymore. I don't know why I'm going to look into that, but it's from 2021. So let's update it. And then the other ones I've got, so episode one, two, two, one, two, six, one, six, five.

We've got three parts of stories from people who've had weight loss surgery. So if you will, if you are a story, storyteller person, then go there, go check out those. So episode 90 is the first one, which is kind of similar to what we're doing today with the stats and stuff. But this is, this is way more in depth. And then we've got one, two, two, one, two, six, one, six, five, the links for everything will be in the show notes. So go check that out if you want to, let's get into it. Shall we? Okay. Let's just do a quick and dirty overview, a TLDR too long. Didn't read. You don't know what TLDR is. Weight loss surgery, what they do. I'm going to tell you exactly the different types of surgery, but they intentionally disrupt a healthy organ function, your digestive system, your stomach, intestines, creating new health risks, putting your digestive system into a disease state in the hopes that you will get a smaller body or you might have health benefits. The outcomes are highly unpredictable and we don't really have any reliable prognostic factors, which is knowing who will likely be harmed, who will have good outcomes, who will die, who might have X outcomes so that you can make a better decision. We don't really have that data. The surgeries are framed as treatments for certain conditions, conditions like tight tube diabetes that thin people also have, but thin people are not offered the same surgery. And we don't have data about outcomes past 10 years really, limited past five years. And that's because there is no interest in studying them. There's no money behind it, right? Because why would we need to continue studying that type of, get that type of data unless we were investigating long-term efficacy in outcomes, which as we know with, you know, dieting and other things that reduce people's weights temporarily, we know the outcomes are probably not going to be that great. People are happy to go ahead with the data that we have already. So there's no barrier there for people to, there's no reason why a company would say, let's give loads of money to see, you know, how well this procedure is working because there's no reason for them, there's no barrier, right? Hospitals are performing them. So the cost, depending on where you live, some places, like if you're in the UK, I think in the UK, you can get it for free. Some places it costs, in the US it costs 15 to 35,000 for the initial procedure. Plus, as you'll see with the data, there's a lot of times you need to have revisions. So there's a cost of the revisions and then the cost of plastic surgery afterwards. There's a lot of costs there. And I think in the UK you would get, yeah, you would probably get plastic surgery afterwards for free, question mark. But anyway, so for people in countries like the US, these are the kind of costs that folks are paying. Yeah. So that's like a kind of dirty overview. You can be like, okay, bye, thanks, we've got the information. But I want to give a disclaimer. All right? I want to give a disclaimer.

And leading into that, here's a quote from Christy Harrison from "Anti-Diet." Here's a little bit from her book. "Lap band surgery is generally considered less invasive than other forms, but it still carries some pretty major risks. Take Sarah Harry's experience for instance. Harry is now a body positive mental health counselor and yoga teacher in Australia, but two decades ago, she was just a young woman in a larger body desperate to lose weight. She had fully recovered from bulimia not long before, but her body image still wasn't fully healed. So she decided to have lap band surgery. Quite pretty much from day one, I was in chronic pain and vomiting, she says, which made her feel like she was regressing in her recovery from her eating disorder. But it was when she had the band adjusted that things got really scary. They filled it up with saline and they filled it up to the top so I couldn't even swallow my saliva, she says. When she called the doctor's office to let them know what was happening, they went into a panic, she says. I had to be admitted to the hospital because you'll die if that happens. You have a very short amount of time actually if you can't swallow. I didn't know that till the doctors told me. Other adjustments were hardly any better. A couple of times they did it too tight and I could only swallow tiny, tiny bits of water, which was of course, which of course put me into the hospital again, she says. The chronic pain also remained. Then, as lap bands sometimes do, Harry slipped out of position within the first year, which caused her to wake up choking in the middle of the night. The doctors told her she had to have a second surgery to get it fixed. So she did. And the problems were exactly the same. Eventually, Harry had all the saline taken out of the band so that it stopped constricting her stomach. All in all, as she experienced, the lap band was anything but low impact intervention. It was made out to be. Of course, not everyone who has one of these surgeries will have major problems like Harry did. I know some people reading this, maybe even you, might have had relatively positive experiences with the lap band or other forms of bariatric surgery. I'm genuinely glad that you're doing well and I don't want to discount the experience of anyone who feels they've benefited from this kind of procedure. What I'm saying though is that if you haven't had one of these surgeries, I don't recommend getting one. The potential for harm is too great to roll the dice. And it's unclear if there are any real benefits. I understand and empathize with the desire to escape weight stigma through surgery or dieting or any other means because the effects of stigma are real and harmful, but bariatric surgery and weight loss efforts pose significant risks to your overall health and wellbeing. And there is no proven long-term way to shrink people's bodies, including by surgical alteration. So that's from Kristi Harrison. This section here is the only bit where I'm actually going to be reading bits from books. That's the longest section I'm going to read by the way. But it's a really important point that I want to make here, which is about what I'm critiquing. And what I think we, if you're interested in fat liberation, should be critiquing. And that is the assumption that fat people must engage in interventions.

Today we're focusing on weight loss surgery in order to be seen as a human, in order to access care, in order to survive in a world that tells us that we are subhuman. It's the systems of oppression that tell society that fat people are less than, and gives the solution as something that causes harm for lots of people. And lots of people say, it's great. It was wonderful. But I want people to have the option to decide not to. So because healthcare is not being held hostage, so many times people are told, you need to have weight loss surgery in order to access knee replacement or to access gender affirming care, or to access IVF treatments. And that is wholly inappropriate because from what we'll see is that these surgeries aren't a failure. We don't have the evidence to say that they work, and the outcomes are really miserable for a lot of people. So if you have or are considering or do in the future have weight loss surgery, all power to you. I don't want to say I don't care, but my fight isn't with individuals. There's this trashy video I was watching yesterday which was like, this man was shouting at a fast food worker because he was mad about something that the company did. And the fast food worker was just being so delightful and saying, oh, I'm happy to serve you. And the guy just looked like a ding-dong, right? And what was going to happen? Nothing. You're just being mean to the server, who's just trying to survive. And that's the way that I see this is that I don't care if someone has weight loss surgery, as in I don't think that they are morally inferior because they've done that in any way, shape or form. And I still want them to be involved and accepted by fat liberation, fat activism. Let me read a section from fat activism, Charlotte Cooper. Fat activism, a radical social movement. I love the colors of the book. It's just like, this is my brown colors. It's like bright pink, yellow and orange. Okay, so I'm reading page 164, just some little bits about this rejecting people. So in the section before, Charlotte has been talking to people about being rejected from fat liberation communities. She spoke about how in the 90s, or I can't remember, sometime there was a pool party and they were asking people what they weighed before they would let them in. Only letting in people who were over 200 pounds and turning away people who were under. I just thought, oh, God, that sounds fucked up. But I understand. I understand the idea of trying to create a safe space, but the way they went about it, it's not so great. While the impetus to create safe space is laudable, the reality of its policing is troubling. And that word policing, I think, is really interesting. The distinction between insiders and outsiders is not necessarily clear. The perceived transgressors may be part of the very fabric of fat activism. They cannot be turned out or avoided nor should they be. As Paz points out, Paz is someone that Charlotte interviewed, what does it mean for folks who have lived a fat life, who have gone through weight loss surgery and are connected to community? I feel like it's a similar question around gender. You know, somebody who is in, say, a lesbian community and has transitioned and now identifies as a man. And that person also identifies as a lesbian. He's a dyke. They're part of that community, maybe leadership in that community. They're already there. Safe space is not safe for everyone who might have a claim to it. People experience painful exclusion when they disrupt the tacit agreement of sameness or are the wrong kind of people or simply reflect intolerable taboos. The intolerable taboo here that Charlotte's talking about is weight loss surgery. Continue, continue, continue, those who do not observe the taboo report instances of shunning and shaming. Kerry had a gastric band and experienced rejection relating to it within fat activism. She explained, this is what Kerry says, "What I've realized through my own experience is that there's a hyper morality and surveillance that operates in the fat acceptance and activist community in some quarters that basically is seeking to reproduce kind of moral correctitude and propriety in its members and to kind of, you know, to position them as morally and politically suspect when they transgress any of the unwritten rules." And then there's another story here about someone called Benjamin who sends a friend request to someone who, a fat activist who rejects the friend request and says, "I don't want to be," because there was rumors that this person had had weight loss surgery because they had a smaller body. So there's the assumption when they didn't have weight loss surgery that they had weight loss surgery. And so then the friend request was rejected because of that. So I don't want anyone to take from both these podcasts that individuals who are having weight loss surgery are not welcome, are morally bankrupt, that those who've decided that weight loss surgery is not for them are superior, and policing people's bodies, which that kind of policing is, you know, is white supremacy, right? That black and white thinking, that either/or thinking, which is what does it remind you of? Diet culture, anti-fatness. So we can't go from one system of oppression, which is policing our body and others, and try and put those ways of thinking into a movement that's meant to be liberatory. You know? You know? Not somebody just doesn't feel good, you know? I don't want to be a, you know, I don't want to be a pool party and then be at the door being like, "Get on the scales,

you're not fat enough." Or, you know, it's just... But also, I want to say I understand very much why people are upset about when people are having weight loss surgery. So I'm going to read a little bit from the fat studies reader. Then we're going to get into the stats. I think this is okay. I guess you can always skip ahead if this is not interesting. Honestly, listen, I got one comment, I got one comment on the podcast, the review saying, "All they do is read from... read things." And I'm so hypersensitive about it now. But... And so... So anyway, if I keep saying, "I'm sorry, I'm sorry, I'm sorry," it's because that one fucking review... Anyway, so this is the fat studies reader edited by Esther Rothblom and Sandra Solovey. And Sandra Solovey does the Flair, the... I'm sure she's that lawyer that does the fat legal rights advocacy people, if you need a lawyer about fat stuff. Anyway, and then we've got this, the Roseanne Benedict Arnold's "How Fat Women Are Betrayed by Their Celebrity Icons." And I think this is a good summary, I'm going to read a few little bits here, of what a lot of people feel about when fat people, whether it be a celebrity or someone in our lives who we thought were... was a safe fat person, has weight loss surgery. So this is about Carly Wilson. I don't know who Carly Wilson is. I think that maybe the... if you're American and maybe know 1990s pop groups, but anyway. So Carly Wilson, celebrity. Wilson, one third of the 1990s pop group, Wilson Phillips is a formerly fat icon who has made a professional transition from fat singer to full-time weight loss advocate. By the way, I Googled Carly Wilson because I was like, "Was she fat?" You know, but yeah, she was fat. And so she was in this girl group. And the... from the pictures, I just, my heart went out to her because I have the impression now I know that she had weight loss surgery, is that she was being compared to the other two band mates. I don't know if they were related or what. The group was called Wilson Phillips. Maybe they were two... it was her and two other white women. So maybe the other two were sisters. Whatever. Anyway, three of them. And then the two others were straight size. And there was a difference, a visible difference between then Carly Wilson who was a medium fat person. They say they even would... they tried to hide her body. They'd even put her body behind a rock one time. So a girl group sporting a fat member was refreshing, even radical. Amid snarky comments about her growing weight and music videos that highlighted the group's sinner members by concealing Wilson's body in shadows, literally positioning her behind a rock, Wilson found acceptance in the fat community. Then it talks about how the things that she did in the fat community. Then, in August 1999, came the announcement that Wilson would not only be undergoing weight loss surgery, but that it would be streamed live on the internet on a website co-owned by her manager. It's fucked up.

In interviews, I'm saying it's fucked up. It's fucked up that her body was being dissected, literally dissected by the surgery, but dissected by the viewers is what I'm talking about. And you know those types of... it feels very gratuitous. It feels very seedy almost, doesn't it? Live streaming a weight loss surgery? Anyway, in interviews, she now portrayed herself as unhappy and desperate. She says, "I've been - oh word - since I was four years old and tried every weight loss method. I've struggled with it, method, I've struggled with it mentally and physically all these years, and I've reached my limit." In an age of rampant fat phobia, Wilson's broadcast of her surgery is a modern age stoning. Log on and see the fat girl atone for her sin of gluttony. Three years earlier, Wilson said, "I feel like I was put on earth to help people like themselves more. I truly like myself." In undertaking this drastic medical procedure which forces a body to reduce its size - even her doctor referred to it as a "induced starvation" - it's difficult to see how Wilson is spreading a message of self-love or helping others like themselves more. Post-surgery, Wilson devoted herself to pursuing weight loss and publicity, advancing the message that fat is always unequivocally unhealthy. She doesn't portray her choices as idiosyncratic, but prosthesises tirelessly, "If I was fat and unhealthy, I was fat and unhealthy, but I'm here to save your fat soul with surgery, joyless exercise and food restriction." Her transparent desperation for attention has found an audience of people grappling with fat phobia and weight obsession. In other words, former and future weight loss surgery patients. And I think this story of Carney Wilson - they talk about other people - Ricki Lake, Oprah Winfield, Roseanne Barr, yeah, I think that summarises that it felt like they were lying, you know? It felt like this person was being deceptive in saying, "I think that fat people are cool, and I like the fat community." And then when there's an option to leave, they do it so

gleefully in a way that harms the community they were just embraced by. It feels like, it feels like, I don't know, your car's broken down and it's a rainy stormy night, and you stumble across a house and you're so relieved, and they welcome you in, and they dry your hair and make you comfortable and warm and feed you a really nice dinner. And you're like, "Oh, man, thanks. That was so nice." And then the next day you leave, you get in your car, and then you write an essay about how that house that you were just at, the soup was disgusting, and the house was smelly and you hate everyone in there. It's kind of like, "Hang on a minute, that was a bit rude." I think that's what it is, is when people are really upset is the fact that often the people who have had, who are formerly fat are often the most anti-fat people out there. And as well, I think it can be very disappointing. The way that I view it, the way that I view it is that these people are temporarily in a smaller body, but very likely in the next one, two, three, four, five, whatever years are going to be in a bigger body again, and are going to be feeling desperate shame. And so I feel like come back to my house anytime. Come and I'll feed you that soup that you didn't like so much, whatever. And if you do end up having a bigger body, you're welcome, but even if you don't, you're welcome. By the way, that celebrity, I Googled her, she lost a lot of weight and was straight-sized and now, what do we think? She's no longer straight size. So I wonder how she feels. She was in an industry that was really scrutinizing her body. And she was known, it says in the book, she was known as the weight loss person to then put on weight. So many of us know what that feeling is like of putting weight on after being so triumphant. And if you were like me, so f****** snotty about it, of being like, look at me, I'm so thin and like you disgusting fatties over there. Why don't you just put down the whatever it is, food that I thought was unhealthy. And then to have to come kind of crawling back, I've been, you know, you know, I'm not crawling back, but that's what it feels like, have been feeling very ashamed. All that to say is I hope that, you know, we don't, no one's shaming anyone. We're critiquing the systems. If you decide to have weight loss surgery, for whatever reason, you can listen to these facts and get a different, you know, a different perspective because a lot of the marketing around, around weight loss surgery is that, you know, it's gonna be amazing. And we don't hear the other side of stories. So much so it's, it's, it's very hard to find stories that don't show, you know, the best thing that's ever happened. Okay. So let's go over the types of surgery and, you know, a little bit of info around those. So people are misled about the extent and severity of, I'm going to stop saying which, where I'm quoting things from, because I'm going to have a, there's a document with all, where all the quotes are from, because it will take forever. Okay. People are misled about the extent and severity of the health risks associated with being fat and told that bariatric surgery is a solution. It's not, it would be more appropriately labeled high risk, disease-inducing

cosmetic surgery than a health enhancing procedure. And unlike a diet, you usually can't abandon it when you realize you made a mistake. So there's three different types of surgeries. One is classified as restrictive, well, two, one's restrictive, one's malabsorptive, malabsorb-tive, and one is both. The lap band and the sleeve are considered restrictive surgeries, whereas the gastric bypass and duodendal switch are both restrictive and malabsorptive. If those categories sound like forms of disordered eating or disease, it's because they are. Christy Harrison says that the amount of people that she sees that are restricted so much by these surgeries, it's akin to being, it's akin to when people are in active anorexia. Okay. So the first surgery, gastric balloon or obera. So the balloon is placed in the stomach, filled with saline, so there's less volume to seeking, you know, it's restricting food. In a study, we see the average weight loss of 21.8 pounds in six months, but then a regain of 5.6 pounds in the next six months, then the tracking stops. So a lot of these will sound familiar of get to a year. What do we know about diets? It's around about a year is when they start failing. So, okay. Another study showed with the balloon, 78.7% of patients regained weight after three years. 78, almost 80% of people have regained weight after three years. 810 device-related adverse effects in 160 subjects over six months. 810 device-related adverse events in 160 subjects. Where's my... What is how many... Will Siri work while I'm on here? Hang on. 160, 810 divided by 160. What's that per person? 810 divided by 160. Five. Five adverse events from the device per person over six months. Five. What the fuck. Okay. At least five deaths shortly after the procedure within three days to a month. FDA received additional reports of deaths from gastric or esophageal perforation. So in plain language, ummarizing that, most people regain the weight from the balloon within a few years and there's real risk of injury or death from stomach or throat tearing. The gastric band, also known as

the lap band. What that does is restricts your stomach size with a band. Like that story that we ust heard of having to have the revisions. There's a high re-operation rate, which is called revisions, up to 60% in some studies. One study shows that 77.3% of Medicare costs for banding were re-operations. 77% of the costs were for re-operations for the lap band. Common issues, vomiting, trouble swallowing, band slippage, or erosion, infection, and severe nausea. It's said, it's marketed as it's reversible, but it can cause permanent damage. So in plain language, summarizing about gastric band, lap band. Most people need more surgeries after getting a lap band and many end up sick, vomiting, or needing it removed. Gastric sleeve, also known as sleeve gastrectomy. So it removes 80% to 85% of the stomach and staples the rest. The common side effects for that is reflux, obstruction, hernias, malnutrition, vomiting, can be fatal. Many regain weight after one to three years, sound familiar. About 25% of people return to baseline weight within 10 years. And that one is irreversible. We can't, you know, the stomach is chopped away. 80% to 85% of the stomach. So in plain language, what we've said there about the gastric sleeve is that a big part of the stomach is cut out forever. And many people will gain the weight back within years and have ongoing digestive issues. Ugh, this most depressive stuff, isn't it? Okay, so the gastric bypass, also known as RU-NY, that shrinks the stomach to the size of a walnut and reroutes the intestine. So bypasses about 30% of the small intestine and it creates intentional malabsorption. I struggle with that word, malabsorption. Absorption. So that means that in malabsorption, the body can't digest food properly. Side effects, malnutrition, chronic pain, digestive problems, and death. One long-term study found about 40% maintained, only 40% maintained a 30% weight loss after 12 years. And it requires lifelong supplements to survive because you literally can't imagine the size of a walnut. Itty bitty baby, tiny thing. A walnut! Okay, so the RU-NY gastric bypass in plain language, the surgery makes your body unable to digest food normally. You'll need supplements forever and most people still regain weight over time. And just another disclaimer, disclaimer, disclaimer. Some people will have any of these surgeries and they have a wonderful outcome. Reagan Chastain often points out there's three outcomes to these surgeries. One, great, fantastic, love it, best decision I've ever made. Second, you have regrets, you have issues, you have intolerable side effects. And three, you're dead. And we don't know which group that you're going to land in, if anyone has this surgery. And you know, the group of your dead is obviously a lot smaller than the other two groups, but when the surgery is not delivering what it's promised, then that's pretty shit, right? We'll talk about informed consent later, but that's pretty fucked up. Okay, the next one, duodenal switch, or if you're from North America, duodenal switch. So duodenal switch combines the sleeve gastrectomy with intestinal bypass. So the sleeve gastrectomy was the one that we did, the gastric sleeve where that's moving, that's removing the 85% of the stomach, 80 to 85% of the stomach. So, the stomach is removed. Then we've also got 75% of the small intestine is skipped versus 30%, which is in the bypass. So it's like the bypass, but it's skipping more of the small intestine. So 30% versus 75%. Extremely high risk of malnutrition and death and often recommended to hire BMI patients despite being more dangerous because it's more dramatic. So the duodenal switch is the most dangerous surgery, it removes most of your intestines ability to absorb food, leading to severe malnutrition and complications. And then a bariatric revision, by the way, the word bariatric means specialization in O word, like a doctor of O word. And so I don't like bariatric, especially because they use bariatric to like bariatric wheelchair, bariatric devices or whatever. So anyway, I'm not a fan of bariatric. Anyway, bariatric revision. So that's when something's gone wrong and then after a sleeve or a bypass or when the weight loss is not enough or if weight loss or if weight has regained. And that further shrinks the pouch size to the size of a dime. It's a dime size. I don't know what dime size is. Dime size. Let's Google it for all the people who are not in America. What is the size of a dime? It is 0.7 inches or 17 millimetres or 1.7 centimetres. It's like a, if you're in the UK, it's like a 10 pence piece. If you're in Canada, it's like the Canadian dime, it's almost two centimetres. The width of your finger, maybe if you have a big finger, do you know what that means? The width of a finger of a person who has a finger,

the width of a dime. So then your stomach is the size of a dime, size of an eyeball, size of an eyeball. That is a good comparison, the size of an eyeball. And then obviously that adds more risk of malnutrition, pain, digestive failure. So in plain language, the bariatric revision is a second riskiest surgery done when the first one "fails" and it can cause lifelong harm and even more complications. We kind of spoke about it in these, but let's go more in-depth on the side effects. So there's a list of complications compiled by Dr. Paul Erzenberger and Sandy Schwartz. I think there is about 60 of them. Let's read them. We'll speed up the audio so you don't have to listen to them. Okay, so the side effects of weight loss surgeries. Adhesions and polyps, massive scar tissue, advanced aging, anemia, arthritis, blackouts, fainting, bloating, body secretions, odor like rotten wheat, bowel and fecal impaction, cancer of the stomach, cancer of the esophagus, pancreas and bowel, chest pain from vomiting, circulation impairment, cold intolerance, constipation, depression, diarrhea, digestive impairment due to heavy mucus, digestive irregularities, daviculitis, drainage problems at incision, early onset of diabetes, early onset of hypertension, electrolyte imbalance, erosional tube, excessive dry skin, excessive stomach ache, esophageal contractions, esophageal erosion and scarring, feeling ill, gal bladder issues, gynecological complications, hair loss, hemorrhoids, hernia, hormone, imbalances, impaired mobility, infection from leaking into body cavities, paragontonitis, infertility, intestinal atrophy, intestinal gas, involuntary anorexia, irregular body fat, distributional lumpy body, iron deficiency, kidney impairment and failure, liver impairment and failure, loss of energy, loss of muscle control, loss of skin integrity, low hemoglobin, lower immunity, and increased susceptibility to illnesses, malfunction of the pituitary gland, muscle cramps, nausea, neural tube defects in your children, neurological impairment, nerve and brain damage, osteoporosis, pancreas impairment, pain along the left side, pain on digestion, pain on evacuation, peeling of fingernails, potassium loss, pulmonary embolus, butyric breath and stomach odor, rectal bleeding, shrinking of the intestine, stomach pain, cerebral irregularities, suicidal thoughts, thyroid malfunction, urinary tract infection, vitamin and mineral deficiency, vitamin and mineral malabsorption, violent hiccups, a persist daily, vomiting from bog blockage, vomiting from drinking too fast, vomiting from eating too fast, vomiting from eating too much, more than two ounces, and best of all, weight regain. Oh my god. If you want to find that list it's in the Health of Every Size book by Linda, Linda Bacon, Lindo Bacon. Some of these things like sound medieval, putrid breath and stomach odor, body secretion smelling like rotten meat, violent hiccups, lumpy body, neural tube defects in your children, brain damage, rectal bleeding. Now, of course, you're probably not going to have, you know, 60 for 60, and maybe you have zero. But I mean, any one of those doesn't sound so great. But I mean, the reality is you probably will have, have let's say a handful of those issues. We'll talk about the main ones in a second. There's that decision of what if, say if you have surgery and you happen to become a thin person, a lot of times what happens with the surgery is that people are not people don't turn into thin person that thin people, they just turn into less fat people and then put weight back on. No fault of their own. By the way, no fault of any weight regain is no fault of the person. It's the product has failed. Right. So imagine if you were the one that was very, you know, you had the goal body, right? Is it like balancing it out? Is it worth it for these other issues? We're going to hear a couple of things from some studies later to, and for some people you might say yes, right? I know, I was talking to, I don't know who I was talking to about this, but I was saying when I was deep in anti fatness, deep in the belief that the nilsus was better, right? That thinness was was more attractive. If someone had said, you're going to have a bleeding bum hole and you're going to have putrid breath, but you'll be thin. Give me, give me that future breath and bleeding bum hole. I'll take it because I'm thin. There's no, there's no doubt. Right. There's no doubt. Actually, when I was younger, I was, I dreamed about getting weight loss surgery. But I think I looked it up and I at that time was not quote fat enough. I had this idea. You know, when like late at night, they'd show the shows where it was like wild girls, but in a ether and it will be lots of videos of young women drunk and then showing their tits. I really thought that that was something that you just did as an, and as an adult. And I was like, Oh God, I can't, I can't ever go on holiday to somewhere like a beta because I have to show my tits on telly. I just really couldn't understand that that's not what everyone did. And I'd be like, look at their tits. They look great. And my tits don't look that like that. And I'm fat. Oh man, I'm fucked. I better get gastric bypass was my thinking. And hopefully, you know, when I'm older, I can get it. So weird clues that I was autistic, like that binary thinking of taking things literally. The developer of the gastric bypass, Dr. Edward Mason said for the vast majority of patients today, there's no operation that will control weight to a quote normal level without introducing risks and side effects that over a lifetime may question rate may raise questions about its use for surgical treatment of fatness. So that's a guy who developed gastric bypass saying, I'm not a fucked up with that one. So let's talk about malabsorption. So you might think, you might think, okay, malabsorption is fine. I can take a multivitamin. So some of the most common nutritional complications after malabsorptive surgeries are deficiencies in protein, vitamin B12, vitamin D, calcium, iron. And because these, these particular deficiencies are relatively well known. Most surgeons will monitor patients for them and will recommend nutritional supplements. Yet patients adherence to these recommendations is decidedly mixed. However, after the surgery, people typically need a special mix and mineral supplements. And they cost about in the US around up to $125 a month because people think that taking the standard multivitamins will do, but it doesn't. You have to take, you know, if you took a multivitamin after surgery, you know, you had blood tests, your doctor will keep telling you, you're low on this, you're low on this. And even if you do take the expensive ones, you're still low on this, low on this. And also your GP, all the time they don't know what someone should be taking, that they need help with malabsorption. So next one, dumping syndrome. Dumping syndrome is characterized by the contents of the stomach emptying too quickly or dumping into the small intestine after a, after a person eats. Dumping into the small intestine. What did we just say about what happens to the small intestine in some surgeries? Some of it, depending, 35, what did it say 35 to, what was it, 75? 30 to 75% of the small intestine is gone. So right. So dumping is dumping into the small intestine. But then what if you also have 75% of your small intestine is gone, that's dumping even faster, right? It hasn't got as much journey to go on. So the American Society for Metabolic and Bariatric Surgery reports that 85% of patients experiencing experience dumping. And so that means nausea, diarrhea, bloating, abdominal cramps, dizziness, low blood sugar, causing shakiness, fast heartbeat, sweating. Sounds like I have IBS, sounds a lot like IBS symptoms and IBS is not fun. It is not. And here's the thing, dumping syndrome can also exacerbate or bring out new mineral deficiencies. And it's not that you just need to adjust after the surgery. It can last a lifetime. Vomiting, 64% experience vomiting 5 to 9 years after the surgery. 5 to 9 years after surgery. Think about with vomiting, what does that do to your teeth? What does that do to your, everything that the vomit is coming up, you know, in your mouth? And then what does the lack of minerals also does to your teeth? A lot of people talk about the teeth falling out because they don't have the vitamins. And if they're vomiting too, then that's going to be damaging the enamel. Big one is substance use disorder. So weight loss surgery, particularly gastric bypass, we'll see alcohol use disorder and drug use at a significantly higher rate after, and also after the rule of why that's a gastric bypass. And risk is especially high in younger men who already drank alcohol. Another study shows that overall prevalence of alcohol use disorder more than doubled by seven years post surgery. Another studies shows that about 20% of patients with no prior alcohol issues reported alcohol use disorder within five years after surgery. And so, you know, one study said that you're higher risk if you already drink alcohol. Another surgery says you don't even need to have any alcohol issues. Some people say like this is the theory that some people say, well, the theory is that, well, people are moving from a food addiction to a substance addiction, but food addiction isn't a real addiction. And what other people say is it's due to substances being absorbed quicker. When a substance is absorbed quicker, it results in a greater high in the brain. And if you have a greater high in the brain, the substance is more addictive. So before, perhaps you could have a glass of wine and, you know, you might be like, oh, you know, that's nice. But then maybe if you're having a glass of wine afterwards, it would have an effect of more than a glass of wine, or if you're taking drugs. So substance use disorder is a big thing. And as well, not only the physical, what's happening in your body physically, think about why people may use substances, no stress or depression or et cetera. And think about the stress or depression that you could be experiencing after surgery if the surgery didn't go the way that you wanted it to. It makes total sense, right? That people may be, maybe, you know, that's a coping mechanism for some people, perhaps. Okay, so mortality. So do people die from this surgery? Yeah, sometimes. Let's look at some studies. Study of 16,000 people. 4.6% of them had died a year after the surgery. And that's for a variety of different bariatric surgeries. Men had a higher death rate, had higher death rates than women. So men died at 7.5% after the surgery, women 3.7%. No stats on non-binary people, gender diverse people. Another study, within 30 days of having the surgery, three out of every 1,000 patients die. So within 30 days, three out of every 1,000 patients die. The Society for Metabolic and Bariatric Surgery, which presents the most optimistic picture about mortality, indicates that two to five out of every 1,000 individuals die within a month. So the last one said three and this one says two to five, which is pretty much the same. And that's from the gastric bypass. And that gastric bypass is the most commonly conducted surgery. One investigative report found that deaths directly attributable to gastric bypass surgery were recorded as deaths from other causes resulting in many never being accounted for. That's tough, right? Because then, you know, many not being accounted for. Well, how many of those people who died after the surgery were said to have died from being fat? Adding to that fear mongering around, you know, a fat person dies, it dies because they died because they're fat. Thin person died, they died because of the thing that caused them to die. Okay. So in the largest examination of mortality rates after surgery, one year after after surgery, approximately 3% of the patients have died. Four years after surgery, 6.4% of patients had died. Seven to nine years after surgery, 10 to 15.8% of patients had died. So Sandy Swartz on the Junk Food Sciences blog, that's a good blog. It's an older one. I wish that it was, you know, still running. Really, it's really good. Compared those rates to the US National Center for Health Statistics of the Centers for Disease Control and Prevention Data, mouthful, matching Americans of the same age and BMI of those numbers, you know, so one year, 3%, seven to nine years, 10 to 15% of people have died, end quote, best estimates bariatric surgeries likely increase the actual mortality risks for these patients by sevenfold compared to someone who's not had surgery with the same BMI. So sevenfold mortality risk in the first year and by 363% to 250% in the first four years. I think those numbers should be inverted. So 250% to 363% in the first four years. Those numbers are from the largest examination of mortality rates, right? And from two different sources, CDC National Center and National Center for Health Statistics, looking at the people the same nationality and same age, there's a between 7% to 363% increase of mortality risks. So the most recent review of the evidence shows that people who've had the surgery have a significantly higher risk of death in the general population, as well as a risk of suicide that is 8.7 times greater in women and 5.5 times greater in men than people who haven't had the surgery. Research is unclear on whether bariatric surgery significantly lowers mortality compared with fat controls. Some studies suggest reduced risk, but these findings may be biased because control groups often had pre existing health conditions, racial differences, or other factors that could raise their mortality. Yeah. So they were comparing people who've had surgery against people who had reduced risk for mortality, but they still found that, well, they found it was unclear. And as well, the survival differences between the bariatric surgery groups and the control groups in most of those studies were modest at best. So any benefits from surgery might have been decreased or disappeared if the research had accounted for confounding variables. So something to consider is something to consider. You could easily Google, how much weight do people lose from weight loss surgery? Does weight loss surgery improve health? And find studies that show we've done a study on a million people and they've, you know, they learned how to fly and their life is great and blah, blah, blah. Yeah. It's frustrating. Something that I really don't like is information not being accessible in a way that most people can access. Because we take the headline and we say, yeah, versus looking into it and saying, is that what I'm getting? Is that what they're meaning? Is that what they found? Like, for example, they could say something is statistically significant. Now, statistically significant means that, statistically significant means that an observed difference between groups is unlikely to occur by chance. So it's not random. So it just means that this is not a random number, right? Whereas people might hear statistically significant and hear the number is big, but that's not what the phrase statistically significant means. And so you might look at a paper and it says, people had a statistically significant amount of weight loss and you would be absolutely, there's no reason why you would not then assume that that means that they had a significant amount of weight loss and just take it on that, right? You need to have almost done a college course in statistics to understand the language. So, do you know what I really wish? Do you know what I really wish? Every single study, research paper, meta-analysis, whatever, had a TLDR of the really, too long, didn't read, right at the top. We found that people lost 12 pounds when they did this. We only, we surveyed white people of the age of 46 and no one else, you know, just something really basic. And so you can go, huh, okay. Versus with language, which is not accessible, it really gets on, gets on my tits. That's why I like making things like it just a little bit like, let's make it, let's break it down, break it down. All right, so we're going to leave it there and then we're going to go into the next episode where we're going to talk about how much weight loss, health, are people healthy, healthy, mental health, crumbling bodies, suicide, we've got so much, we've got so much to go. Okay, so we'll leave that there for this episode and then come back. I'm going to get the episode out in the next two weeks for the next, next part. Okay. Okay. Oh my goodness. If you appreciate the work that's gone into this and you want to support the show, you can go to Kofi. Kofi, the link will be in the show notes, link for everything. Everything that I've said, every word, every study, everything will be in the show notes. All right, we'll see you in the next episode. Stay fierce fatty. Remember you're worthy, you always were, you always will be.

Fatty hugs.