Episode 202 Transcript
You're listening to the Fierce Fatty Podcast, episode 202, "The Truth About Weight Loss Surgery: Does It Really Make You Thin and Healthy? Part 2. I'myour host, Vinny Welsby. Pronounce They/Them". Let's do it.
Welcome back, my fabulous fatties and fat allies to part two of this. It's the next day in my house, wearing a really fluffy jumper because it's a little bit cold today. With a setsuma or tangerine on that I got from the YVR fat clothing swap, which is in Vancouver. If you're in Vancouver, then come along to the clothing swaps because they're so much fun. Even if you're not into clothes, it's just so much fun to hang out with that community. It's just, because you know, how often as a fat person do you get to be in a, in a changing room with, uh, trinone clothes? I don't think that, uh, in my life that's happened maybe a handful of times. And a lot of times, I was traumatizing because you're with thin friends and you know, I'd be trying to squeeze myself into a thing that was way too small, uh, because I was too embarrassed to tell them that the store didn't carry any of my sizes. This is when I was a teenager. So, uh, come along to that. This podcast has been a boost. Oh my goodness. I think this is the most in-depth, detailed research collection of information that I've done for a podcast in the 202 podcasts that I've ever done. So if you appreciate this work and you want to donate, go check out links below to find Kofi. You can do a one-time donation. You can do an ongoing donation. It would be so wonderful if you can do that. If you are not able to, and you just want to, uh, support the show in another way, you can always, always write a review or not. I'm not the boss of you. Do what you want. You can just listen and hang out and do nothing. That's fine by me too. Something that, so last time I said that I've started my master's in counseling, which is really exciting, the amount of times that I'm like, Oh, I need to tell people on the podcast this because it's really a lot of, a lot of what we're, so the first I've read in halfway through first two courses. One of the courses is about diversity, which obviously I love. And the other one is like how to be a counselor. The diversity one was so interesting. Both of them are really interesting, but the, the, the diversity one, you know, talking about identity and, um, there's a model that I want to talk about probably on the next episode. And the model talks about how we move from, if you have a marginalized identity, for example, being fat, the process that a lot of people move from is unless you've been, you've been raised in an environment that is accepting of that identity, but you know, with fatness, most of us haven't going from hating that identity and, and appreciating or loving or worshiping dominant identity, which is thinness and how folks can move through this processes of state stages to begin to accept their identity. And so they might go to accepting identity, but still cherishing the dominant identity and then to accepting their identity more and then hating the dominant identity. I see this loads. It's so interesting because I'm like, I see this, see this all the time. And here's a model that explains it is that when people are newer-ish to fat liberation or, you know, this journey of, of accepting fatness, they should be really angry at thin people. And I get it, I get it. Because you're realizing, oh my God, all this time I've been worshiping thinness and that's not been helpful for me. And so rightly so, you know, your brain says, you know, you should be angry at those people. And then you see posts like real men don't like bones. What is that one? What is that one? Like real men like meat and they don't like bones or something? To say like real men like fat people and don't like straight size people because straight sized people are bones or something. Anyway, whatever it's derogatory towards straight sized people.
And that feels empowering for people. Right. And then they move to, then they finally, hopefully, will move to the final stage, which is, you know, appreciating, loving their identity and also appreciating the things about the dominant identity without that kind of worship. So loving everyone, you know, appreciating everything. So maybe I won't because I would just, maybe I won't do the next episode on it because I just explained it. But that's the next episode, but maybe I'll do that. And then some other, some other things as well, like other models which are, which I find really interesting, and hopefully you will. All right. So let's get into the next part of this. Last episode we covered so much, data about the different types of surgery. And then we got started into side effects. We looked at mortality, we looked at substance use disorder, dumping syndrome, malabsorption, et cetera, et cetera, and that whole big list of side effects. Whew, it was a lot. And so today let's start with the big question. How much weight do people lose? And the answer is, the answer is like, like we discovered in the last podcast, a lot of the times the science is, is, is shoddy, a lot of times the science stops at a few years after they, you know, start, when they start following the subjects. So a lot of the answers around weight loss surgery is, we just don't have a lot of good data. But what we do know is that, the majority of people who have bariatric surgery regained some, all of the weight they lost two years after surgery, 46% of patients have had significant weight re-gain. By four years post-surgery, that number jumps to more than 63%. So 63% by four years significant weight gain and likely continues to grow as the years go on. And again, we say likely to continue because the data stops being tracked. Again, reminder, absolutely everything that I'm reading out. I'm thinking maybe I should even put into like a big, like a book or a download or something, because there's so much here. So much here. Maybe while I do that, I can just, you know, you can have the raw kind of not tarted up looking fancy data. Also, rewind a little bit, if this reminds me, I want to say something. The nice thing about that, I recorded the first part yesterday and today is in between today and I say yesterday, my brain has been percolating. You know something, we started yesterday with like a disclaimer about if you want to have the surgery in my mind, in my mind, I don't think any less of them. What I think is that they just have made a decision that they feel that it's best for them to protect themselves from anti-fat bias, to reach goals, whatever. They've given, they've taken the information that's been presented to them and made a decision that they feel is best for them. I use the idea of what people struggle with about, you know, if you were to stop in the middle of night and then you go to someone's house and theyhelp you and then what we struggle with is the fact that, you know, people come into the fat community, get love and acceptance and then, you know, say, "Fuck you, fatty losers" when they have lost weight. And I think that's what a lot of people struggle with. I said to, I said, you know, they're always going to be welcome back into my house.
I want to caveat that because I don't want anyone to misinterpret what I was saying with that. That's not me saying that I think you, or I think me even, should accept shitty behaviour, right? So, you know, if that person that was in my house and said, "Your soup sucks, you fucking loser, can I come back in?" You know, I might be like, "You can come back in," you know, because I can see that it's raining out and you need help, but there's some rules there. You know, "We're not going to be, you're not going to be shitting all over my soup," which I actually quite like. And so, "Can you keep your soup opinions to yourself?" Or, "Maybe you, you, here's your room, you go hang out there and I'm going to be in a different room," right? So, that analogy meaning that I am in community and will always be in community with other fat folks who have different histories and opinions and whatnot. And that's just the nature of community. However, it's important for me and my mental health not to be besties with someone who's like, "Vinny, your body is fucking disgusting. You should do weight loss surgery like me because now I'm sexy and you're a piece of shit." You know? Like, no. No. I just want to make sure that that's not what I meant. And also, if that works for you and you have people that, obviously people are not going to actually say those things, but they do. I was doing an extreme version, but they do. In my life personally, I don't know any, I don't have anyone who actively talks about fatness as negative. However, I do know one of my friends is taking weight loss medication, weight loss job, GLP, we go V. And whatever is what I think, but it's got nothing to do with me. And also I don't want to create an environment where that person thinks that I think that they're a piece of shit. Cause I don't. Really, I don't. I don't. It might make me pause a little bit to say, are they safe? I won't think, are they judging my body? Cause I know everyone's judging, we're all looking at each other's bodies, but I don't care if they are looking at my body going, "oooh." I don't think they are because a lot of the times we're focused on our own shit, right? Our own bodies, if we're struggling with body image issues. So anyway, I hope that makes sense. And I hope there's clarity there. Cause I hope no one went away and was like, Vinny's saying that I have to be nice to people who are being really mean about fat people. I mean, you can be nice to them or whatever, but you can also make decisions to protect your mental health and that could be having them in your life. That could be reducing the amount of time you spend with them and that could be, not spending time with them. And also all of those options come with, you know, layers of difficulty and needing privilege in lots of different aspects to be able to say, I don't want to be friends with someone because, you know, anyways, lots of complicated decisions and whatever you decide is perfect. Great. You know, you're, you're, you're the, you're the person who gets to decide how, what, what things feel good or not so good for you. Anyway, back to the weight loss. How much weight loss? Okay. So this next study says that weight regain is common with surgery with a study showing that only 40% maintained at least 30% weight loss. So we mentioned this, this one, one line before, but we're expanding on it here. So at 12 years, at 12 years, so 40% maintained a 30% weight loss. So the 30% was touted as the kind of the big woo number, right? So at 12 years, but 93% maintained less than 10% weight loss. So 93% of people who had weight loss surgery at 12 years post surgery had lost, had maintained a less than 10% weight loss. So 93%, 10% weight loss, 70%, 20% weight loss. This is all at 12 years, 40% a 30% weight loss. The guy who, the guy who developed the, the bypass, remember he said, this is a quote from the last one, that no surgery is going to make someone a quote, normal control weight to a normal level. And this is what this data is showing, basically is that it looks like for the vast majority of people, 93% from this, from this study, this one, this study came out in 2017 from 12 years post surgery that 93% people have got about a 10% weight loss. So if you're 300 pounds, that's a 30 pound weight loss. So you've gone from 300 to 270. So you're still a fat person is the outcome, and is a 30 pound weight loss in exchange for the outcomes. Even if you have, imagine you don't have, say you have no bad outcomes, no side effects, you still have a digestive system that is, is damaged potentially for life, where you can't enjoy food in the same way. And you have to take lots of multivitamins to compensate because you can't get enough nutrition into your body. For some people, they might say, yes, that's worth it. That's 30 pound weight loss, because a 90% chance of a 30 pound weight loss is worth it for me. Let's see if you've got the, if you're, let's work out what it would be if you had the best success according to this. So you're, if you're a 300 pound person, so the, the, the, the kind of touted as the, the best outcome would be losing 90 pounds if you're a 300 pound person. So you'd be a 210 pound person.
So again, you wouldn't be a straight size person. Maybe you're like on the, on the, on the border, on the borderline, maybe, but probably not, you know, when I, when I think about weight loss surgery when I was younger, I, I thought that it's, you know, you go into the, be a straight size person. Not the, not that you're going to be a slightly less fat person. I wonder if people knew that it wasn't going to make them into a straight size person likely if that would be a big reason to not do this. I know a lot of people say, well, it's about health, which totally, but you know, deep down, deep down, people say it's about health, it's about health. But then deep down, it's about health and it's about how they look cosmetic surgery. And so I wonder if people knew they could engage in health promoting activities and, and improve their health through health at every size interventions, which would mean that they, they likely stay the same way or do this surgery and means that they might be a little bit less fat if they would still be choosing the surgery. I'm curious. I'd love to, I want to ask some people, I need to know people's opinion, but it's kind of really, that's a hard question to answer because it's, it's, it takes kind of like, you're removing the layers. You could probably ask people who've already gone through the surgery and, and, and who, who kind of understand about it more now and ask them their opinions of what they thought at the time. They probably would be able to be maybe a little bit more reflective. Maybe, who knows? Okay. Another study says most patients maintain initial weight loss in the first one, two years. Sound familiar? But what weight regain is common by year five, demonstrating variability in long-term outcomes. That was a five-year study. Next one says long-term weight regain, five-year study. Okay. This one's for gastric bypass. Five-year perspective study shows that while initial weight loss is substantial, quote, so, so this is, this is, remember last time we said, I said about statistically substantial, that does not mean that it means a substantial amount of weight loss, but statistically substantial means that how likely is it that these results are not due to chance, right? That these, these results are, these numbers is, is because of the thing that we're looking at, right? And so I looked into what they meant by statistically substantial and the, so let me read it again. Five-year study shows that initial weight loss is, is substantial, statistically substantial. And what that meant was 55 to 110 pounds for someone who has a BMI between 40 and 50. So a BMI between 40 and 50, which is what they're the people in this, in this study that around about their BMI ranges were. So substantial is 55 to 110 pounds depending on your BMI, substantial, but then most patients experience weight gain afterwards and about 50% of patients experience weight regain by 24 months after the surgery. So it'd be really good to know, we've got these number like weight loss, but what does that actually mean? Does that weight loss mean that they are healthier? What we knew, know from another, another study that was quoted yesterday was that the more weight you lost, lost the worse the side effect and the outcomes were. Like your health, your health declined the more weight you lost from, from surgery. So do we even want to be losing a lot of weight? Because you know, the more weight that you're losing from this surgery means the more higher chance of, of worse health, health outcomes. So something that Reagan Chastain points out is that there is an issue with weight loss surgery study. So a quote from, from Reagan in this study, she's talking about a study about life expectancy, in this study about, about surgeries, "the surgical group's life expectancy is still 5.5 years less than the general population." So people who had the surgery, their life expectancy is 5.5 years less than the general population.
"Since the control group's life expectancy is subject to the dangers of weight loss interventions, which are associated with higher mortality and has, and since studies show that the risks of for all cause mortality and health hazard ratio can be attenuated or eliminated by weight neutral interventions, I have to wonder where the life expectancy of a weight neutral group would fall." So this is a really fantastic point that the, a big issue with all these studies is that we are not comparing a control group that is engaging in health at every size or weight neutral care or receiving weight neutral care. And this would, this would be kind of difficult as well to, to do, people who will not be experiencing anti-fat bias. As Reagan points out, "the general population will be dieting and experiencing bias." So it's an almost impossible thing to, to, to, to not have someone experiencing bias, but what we can do is compare someone who is going through weight loss surgery with someone who is going through weight inclusive care and look at those differences. The other point here that, that Reagan is making is that the surgical group, their life expectancy was 5.5 years less than your, than the general population. But the general population is also experiencing harm from anti-fat bias. And so we have that extra layer of, but what if underneath that they weren't experiencing that, what then would the life expectancy be? Theoretically, the weight loss group, 5.5 years less life expectancy would, that number would be higher. If theoretically what we're assuming is that weight neutral care actually helps people improve their health and deal with the burdens of anti-fatness, marginalization, stress, stigma, all of that. And so theoretically we could have three numbers, the life expectancy of someone who's had the surgery, life expectancy of the general population, life expectancy of someone who has access to weight inclusive care. Now that would be interesting, wouldn't it? Oh no, oh no. But even so, they're saying that the life in this study, the life expectancy is, is worse for people who have had the surgery. It's just better just to not and experience weight bias is what this study is saying. Okay. Another study says in a cohort of adults after surgery, various ways to measure weight regain, kilograms BMI, et cetera, were compared. The measure of percentage of maximum weight loss had the strongest association with adverse clinical outcomes, age, diabetes, progression, hypertension and better model fit. So I didn't, so this study was actually right here. I didn't mention it yesterday. So if you're like, well, I don't remember that study, it's because I hadn't told you about it yet. Um, yeah. So this is the study that says greater weight loss with after surgeries associated with poorer health outcomes. All right. So, so does it make you thin? Uh, uh, uh, I don't know. You will might help you lose weight a little bit. Maybe, you know, the same with diets, right? You know, do diets work? Yeah. Temporarily. Um, and this is what the data is showing, but we don't have the full picture of data. This is what the data is showing. Also yesterday I mentioned about why would money be put into research for weight loss surgery to see the outcomes longterm. The other thing that I didn't mention is that these are not like a, uh, like a drug. The, a company will own the rights to the drug, right? For a certain amount of time. And so they have exclusive rights to this drug. Um, people, companies don't have rights to these procedures. They can invent a new one. You know, like how they invented, what was that one that was in Oswego in the, in New Zealand and they, it was like, oh yeah, the jaw wiring thing. So it was, I think about three, four years ago, I'm sure I must've done a podcast on it. They invented this new life-saving miraculous thing, which was magnetically wiring people's jaw shut. Amazing. Doodly-doo.
Because that was a new medical device. Um, the magnets and the magnets are obviously mad strong. So unless someone comes up with a new way to do weight loss surgery, they would be, by doing research on the outcomes, again, there's no barrier, there's no reason why they would need to, but it's not going to benefit the people who are doing the research necessarily like as in a company funding it. Why would they, you know, there's no benefit to them. They don't have patents, they don't have ownership of X procedure. So, okay. So doesn't make you thin. The, the, uh, the side effects are horrific for many people. And again, some people will be, some people will be, Hey, I'm, I'm so thin. I'm actually a supermodel and actually I've had no side effects and my life is amazing. 100%. There's, there's loads of people who would say that. And that's absolutely true, right. But what we're, what we're, what we're learning is that it's, you know, it's probably not likely. So, but does it make you healthy? Does it make you healthy? Who cares if it doesn't make you thin, if it makes you healthy, right? So another issue here with, with, uh, the studies around health, many studies ignore serious or lifelong side effects. So we don't actually know if patients end up healthier after surgery. So the emergency care research Institute, an independent nonprofit profit health services, research organization conducted the most comprehensive review of bariatric surgery, analyzing evidence from 70 studies. They found that although patients experienced significant weight loss, significant, most remained in the O word range. The review also highlighted that evidence showing improvements in related health conditions was limited and it was unclear where the surgery effectively treated heart disease or increased lifespan. Claims regarding enhanced quality of life and longterm health benefits were reported as inconclusive. Another thing that the theme that came out in the studies is that we have data suggests that people experience that gradual weight regain and return of comorbidities, health issues during the longterm. People are experiencing weight loss and their improvement in health markers in the shortterm. That's when the, um, the weight loss surgery surgery and is getting on for a testimonial, Oh my goodness, I've lost so much weight and I don't have type two diabetes anymore. And lasers, lasers have come from my eyes and now I have x ray vision and blah, blah, blah. Um, but then if they did that same testimony 10 years later person is probably going to be like, yeah, I'm, I'm fat and I now have type two diabetes again, but we don't see that. Right. Okay. So another study observed that many diseases including sleep apnea and diabetes tended to reemerge and even worsen longterm following weight loss surgery. And that was when they say longterm three years post surgery. Another one in a review article, uh, while many people experience improvements in type two diabetes, some patients remain symptomatic experience a recurrence or also experienced worsening of symptoms following surgery. Okay. So we have very, very little research on this beyond 10 years and most longterm studies only focus on length of life, not quality of life. And that's really important. I think, I think most people would say like, if I could live to a hundred, but I knew that from age 70 to a hundred, I would be really, really sick. And my quality of life was really low. And I just, it was awful. I'd rather just live to 70 and have a good quality of life or maybe 80 or what, you know, whatever. Um, and I think that's really important because what's the point of, what's the point of doing this if your quality of life isn't great and we're not measuring quality of life. And that's important. Something else is that it's logical to assume that because people are experiencing a lot of weight loss right at the beginning, it's muscle that losing not fat and muscle is really, really valuable tissue. The social approval of weight loss after surgery can make people way less open to share reports of complications or reduce quality of life. And this study shows that even those who experienced serious side effects still often report an improved quality of life. And that's from the Rue on why gastric bypass. You know what? And I think a lot of that is shame, maybe even denial as well. If I think about in my life, when I've got caught up into something and I'm like, yeah, this is going to be great.
It's really hard to say, Oh, it's not so great because it kind of feels like you've been tricked and it kind of feels and it feels then, then you feel like I've done something unintelligent. I'm a fool. It's like, you know, I think about is like people who have got, you know, love scammers, love cons and they, that's sunk cost. They've got someone who is scamming them for money, but they think that they're dating them and they feel really, really embarrassed when they realize what's happened. And also a certain time they might have doubts. Maybe their family member says, I think this person's taking you for a ride, but they've already given this person X amount of money. And to admit that this person is defrauding them is really difficult and painful. And they still have hope, right? And so, and they might get their money back. If I maintain a relationship with this person, you know,why break off? I'm going to lose my money. And I lose someone who's potentially a lovely person who's not scamming me. And it takes time to get to that point where you're like, Oh, they are scumming. And so I, I, and I think that that's just a normal thing that human brains do, right? It's not that these people are, are silly or unintelligent or whatever. They might be more vulnerable and we're all vulnerable to, to scams of any type of scam. And think about as well with weight loss surgery, how vulnerable are those patients? Whether they've been told they have to do it to access care, whether they've lived their whole life dealing with anti-fatness, whether they are excluded by friends, families, loved ones, they are in a much more vulnerable position to make a decision that's less empowering for them. Or maybe not. Maybe they're not, maybe they're not vulnerable, right. But I would say that it could be more likely they're vulnerable. So let's talk about mental health. Mental health. All right. So study shows that many patients continue to experience depression, anxiety, and binge eating behaviors post surgery. Some improvements are seen, but psychological challenges remain long-term, including surgery and indicating surgery alone does not resolve these issues. The surgery doesn't fully fix mental health or eating problems. I would say, you know, doesn't fix it at all. Why would, why would forcing your body and brain into a starvation mode of fix a mental health condition? And that makes sense. People think it will because they think that binge eating is because they're greedy and lazy and out of control, but binge eating is because they have spent too much time controlling and thinking about food and how to not let themselves have food. It's a restrictive eating disorder, right. But because it involves eating versus not eating, people have put the label on, oh well, it's something that fat people experience, because they're so fat and lazy and greedy and blah, blah, blah. But it's a restrictive eating disorder. So the answer to a restrictive eating disorder is not to restrict that person even more. That's not how you fix it. The answer is to allow yourself all the foods, get support from someone who is an intuitive eating person, coach, dietitian, therapist, a fat positive therapist, et cetera. And allow yourself the food because then you'll realize that you're not actually addicted to it or whatever and it takes it anyway. So whatever. The answer is not to make your stomach the size of a walnut. That's not going to fix a mental health problem. Yeah, so another study shows that a qualitative review finds that patients experience challenging body image, altered relationship to food and social identity shifts post surgery. Surgical outcomes are both biomedical and psychosocial. So basically they're saying like life after surgery is complicated. It changes your body, your food, your social life. We'll get into more what that looks like in a second. Another study shows recent weight based stigma amongst bariatric patients correlates with worse psychological outcomes, higher depression and anxiety, and poorer behavioral outcomes, eg eating behaviors, highlighting the ongoing role of stigma post surgery. So what that's saying is that people still face stigma after surgery, which makes mental health worse. And I think that that, you know, they're saying worse outcomes. And I think that's probably, if you're expecting that this surgery is going to have this, you know, these, these positive outcomes in your life, and then you still experience anti fatness, it's probably hits harder than if you're, you know, your pre surgery where you have, where your brain brain might be saying, yeah, I deserve this anti fat bias because you know, I'm a fat piece of shit. After the surgery, you've gone through this really, really huge thing and lost weight and almost, I think about it as, hey, hey society, I've taken control of my life and I'm doing what I should do as a good fatty and I've lost weight. And then that society is just like, don't give a shit. You're still fat, you loser. And how, just how devastating that would be. Oh, can you imagine? And even if you have lost, even if the person has lost all of the weight, they're thin, they would still not adhere to beauty ideals because they would have lots of skin, right? So, so then, then if they are then straight sized, but then they have this skin, they could easily be the victim of, of anti fatness. When some, like say if someone saw their body and saw like, oh, look at all that skin and, Oh, that it looks, it looks fat and blah, blah, blah. But you can, it would be devastating. Hey, I've come, hey, I've chopped off most of an organ to satisfy you and the person's not satisfied and the person being society. The person, and that's for everything. That's for everything. You know, no matter what we do, we can't win. I've spoken about this, like the house always wins, you know, a gambling example, the house always wins because there is no winner. There is no winner when we are comparing bodies, when we are looking at body hierarchies, the winner might be at the top. You know, the young, rich, white, non-disabled, straight size, et cetera, et cetera.
But that person still has something that is quote wrong. And then they age a few years and then suddenlythey're not on the top anymore. Or, you know, they become disabled and suddenly they're not on the top anymore. It's like this illusion of, of, you know, rotating on who's on then top, but really the top is not the top because the top doesn't exist. The top is, you know, this oppression, you know. So there is no winning. There is no winning because there
will always be something else about you that is wrong. And you will always every single day be getting older. You will always every single day be getting closer to potentially being more disabled or disabled if you're not currently disabled because you will be aging. And if you're lucky enough to live long enough, then you'll become disabled unless you're hit by a bus or something. And it's really sad to realize that. It doesn't matter what you do. The society's not going to be like, okay, you've made it. You're going to stay there forever. You're at the top of the top of the triangle. You're gorgeous and amazing. And we love you. That might last for a half an hour, you know, not half an hour, but you know, a certain amount of time. And then you're off the top, just trying to get back or get to the top of that pyramid. It's like, it's like made of sand almost. It's like can't, it's not possible. You know, I think about like the casino exec in like a, a tower at the top watching all of us scrambling to get to the top and we're throwing money. We're throwing money. I'm going to be the winner. I'm going to, Oh, had this little win. Oh, I'm going to make it big this time. And I'm going to, I'm going to get there. And the casino exec is just like, yeah, keep going. And that's systems of oppression. That, that, that comparison systems of oppression. Yeah. Keep going. Keep going. You know, you're supporting white supremacy. I love it. Love what you're doing. Yeah. You don't have a fly gap. Oh, you're a piece of shit. Oh, okay. So this other surgery longterm post-surgery patients report persistent body image issues, social challenges, challenges, and shifts in identity indicating ongoing psycho, psycho-social impact beyond biomedical outcomes. From that study, we've got, if you're, if you're, if you're looking for some stories, this one here, so I'm going to read a couple of stories. So under the section of like the outcomes after surgery, one of the titles is crumbling bodies. So this is someone's story. It's not too long. You know, I was about 342 pounds before surgery in 20 in, so before surgery in 12 to 18 months, I went down to 209 pounds and I'm, I'm pretty stable there. I'm satisfied with my weight. That's no problem. I reached that goal. And in the beginning, also my primary goal of better health, but then it just messed up. I still have problems with diarrhea and constipation, alternating each other. I've also noticed a personality disorder, but that does not necessarily relate to the surgery directly. It may be because the body is so run down that the research asked me, do you think that the, about do, but do you think about your surgery often? I try not to think about it in daily life, but you notice them, the health problems all the time. You cannot avoid them. You have to plan everything. It is not easy to do something spontaneous. If it is a diarrhea day, I cannot go into town. And if it's a constipation day, I cannot go either because of the pain and I need to bring emergency food to avoid the blood pressure. Interview says, because that can just happen. Yeah. I have tried to figure it out so I can be ahead. Dropping blood pressure and bone density is not a good combination. Laughing. It can become interesting. Researcher, do you think about it a lot, how the future looks? Of course. I'm concerned. Before I was at risk of heart attack, diabetes, all those things. And statistically my family haven't raised the average age. Don't know what that means. Now after surgery, I wonder, am I really better? I am 35 years old, having high risk of osteoporosis, blood pressure problems, and all kinds of things. Because I am used to in my job at the nursing home at 70 plus. So what is happening?
There was another story in there, which another kind of life change that people are dealing with is shame. And the shame that people are saying that they took the easy way out. The shame someone says, I can't be proud of the pounds I've lost because it's not me that's done it. I can't celebrate myself. And people saying to them, well, you've taken the easy way out. I think that's bullshit. You know, take it, does this sound like the easy way out? No. No. Have the, have people who are engaging in weight loss surgery often spent their whole lives trying to be thin. Does that sound easy? No. No. I think that's just the easy way out. No, this does not sound, this sounds really, really, really difficult. And then he just goes to show that what people are looking for is self-flagellation, right? They're looking for fat people to suffer. So again, it doesn't matter what you've done. Okay, well I've done, I've cut off most of an organ. I don't care. You did it in an easy way. Therefore, you're still a piece of shit. You can't win. You can't win. And Roxane Gay talks about this in an essay, "What Fullness Is" and saying that surgical, surgery doesn't automatically resolve issues with fullness and eating. So the next thing to consider is a huge risk, a huge outcome on health. You know, we talk about mental health is suicide. There's an amazing, amazing piece in, I don't know how to say her last name, Lisa DeBrile, De-u-b-r-e-i-u-i-l, DeBrile, and Alexis Connison, both are well known names in this world. They wrote a piece for "Bariatic Times," which is obviously, the location is perfect. They've written it in there so that the people who are performing bariatric surgeries can read this piece. On, the piece is titled, "But everything is supposed to get better after bariatric surgery, exclamation point, understanding postoperative suicide and self injury." Now, they have about 75 billion links to meta-analysis and studies, and I'm going to highlight just a few. It's like overwhelming the amount of evidence around suicide and self harm risk. So first off, we've got a meta-analysis of 28 studies. So a meta-analysis is when they, we have lots of different studies and we bring them all together and we say, what are those, that big group of studies saying? Get the data from all of them, okay? So we have 28 studies and that's 23,885 people, so almost 24,000 people. So that means that the data is probably better because we have more numbers versus if we have a study that's like, in three people, two died by suicide. Therefore, you know, it's not really helpful. So in a meta-analysis of 28 studies, 24,000 people, the suicide rate was 4.1 suicides per 100,000 people. The general population is one suicide, not 100,000, probably 10,000, but the general population is one suicide per 10,000, which means that there's a four times higher risk. So that's really good data because it's of 23,885 people, so the four times higher risk. Another study, there were 31 suicides among 16,683 patients and the rate was 6.6 per 100,000 people a year. The mean time to suicide was approximately three years post-surgery. Men have a two time higher risk versus women, no data on gender diverse people. The mean age of death, 45 years. I just imagine these folks and we're going to talk about why in a minute, let me, I'm going to pause. I'm feeling deep empathy here. Okay. Next study, 4% suicide deaths, 3% overdoses from this study, but the overdoses are reported as overdoses. So there was 14 deaths from overdoses, which is 3% of the sample. They weren't classified as suicide, however it's possible that some of those deaths were suicide. And so the authors of this study concluded that there is an excessive rate of suicide in patients who undergo bariatric surgery. Another study says suicide and self harm is 1.78 times higher in people who've had surgery. And RU-on-Y patients are 3.5 times more likely to attempt suicide than a lifestyle modification group. So the RU-on-Y surgery was the most dangerous of all the surgeries in this study for suicide and self harm. Next study, self harm requiring ER care was three times higher post surgery. Final one, women are 4.5 times more likely to die by suicide. Those with a history of self harm pre-surgery are 30 times more likely to engage in those behaviors following surgery. So if you have no history, there's still a heightened risk. If you have a history of suicide ideation, self harm, suicide attempts, 30 times more likely to engage in those behaviors following surgery. It's really staggering. So there's lots of proposed reasons. The list is unrealistic expectations. And by the way, unrealistic expectations is not due to the patient and it's not the patient's fault. If we're all saying, "Well, surgery is amazing," and then the doctor is saying, "Oh, yeah, yeah, yeah, it's great, but you know, there's a couple of risks, but it doesn't happen to anyone," the expectation of being unrealistic is the fault of healthcare professionals and society.
Okay, so reasons, one, unrealistic expectations, two, core quality of life, three, depression, four, weight regain, five, recurrence of medical conditions, six, eating disorders and distorted body image, seven, alcohol and substance use, eight, metabolic changes. So I'm going to talk about the metabolic changes causing suicide, but the quality of life. So this study found that poor quality of life issues were present preoperatively and persisted postoperatively in combination with unrealistically high and thus unmet expectations of surgical outcomes by the patient caused the increased risk of suicide, which makes total sense, right? If you're life is, you've got a poor quality of life before and you're doing this thing that's going to improve your quality of life and it doesn't. And then what happens is people blame themselves. Same with diets. You know, with diets, I can't stick to this diet. I'm terrible. I'm greedy. Where's the surgery? I feel like it's even more heightened. Like, look at me, what's so wrong with me that I've had surgery and still I'm so greedy. I'm so out of control. I'm so my body is so wrong and it's not them, it's the product that is wrong and faulty and everyone else is in the same boat. Not everyone, obviously, but you know, if they could talk to their peers and say, Hey, how's everyone else doing with the surgery? Are you all like, you know, running through meadows and, you know, cuddling puppies all the time? And, you know, and if they could hear the stories of, you know, you know, actually, it's really fucking shit. Well, no, actually I feel, you know, I lost weight, but then I gained it back. And wouldn't that be helpful? But we don't have those types of resources so readily available. If you Google anything to do with this stuff, it's so hard to find anything where it doesn't say that bariatric surgery has changed my life and was the best thing that I ever did, which is absolutely true for lots of people. And the opposite is absolutely true for lots of people too. And I think just talking about this may make people feel less alone, right? Versus making them feel that they're at fault because they're not. So the metabolic changes following surgery that causes suicide. This was really interesting. So this study noted that ghrelin, a peptide hormone. So ghrelin is like the hunger hormone. So ghrelin, and by the way, if you're dieting, ghrelin is like, bitch, eat, come on. So you're getting more ghrelin to tell you to eat. That's why, you know, when you're dieting and lots of different things are happening too in your body. But our body is helping us being like, let's turn up the volume on the hunger hormone so that this motherfucker eats something. And then we're just like, I took that as like, I'm obsessed with food. But my body was like, Hello, we're starving over here. Okay. So, so this study noted that ghrelin, a peptide hormone that is decreased following bariatric surgery, is often implicated in suicide risk. There is some research to suggest that a decrease in ghrelin levels might be related to increased depressive symptoms and suicidal thoughts and behaviors. While an increase in ghrelin might have an antidepressant effect, ghrelin has also been implicated in learning, memory, reward, motivation, stress response, anxiety and depression. And this could be because of its role in regulating stress response, influencing reward pathways and promoting neuroplasticity. So this hormone is being messed with. And literally something is happening in our brains where we're not getting that good ghrelin juice. And that could make folks feel depressed and have suicidal thoughts. And that's just like a one factor. And there's so many, all these other different factors. They have that literal hormone change. And we're just talking about one hormone here. Think of all the other hormone changes that are happening. And lifestyle stuff and you know, maybe previous enjoyment that you got from food that you can no longer have. And then the other, the disappointment, all of that stuff is piling on and on and on and on and on. Another thing to think about is that there's racial disparities. This is like generally, so that's suicide there. But now we're moving to racial disparities. So black patients who underwent surgery in Michigan had significantly higher rates of 30 day complications, higher resource use and less weight loss at one year compared to white patients.
Another study shows that black patients always also had higher odds of readmission and death while Hispanic patients had higher odds of severe, grade three complications than white patients. And that's by the way, that's not because there's something wrong with racialized patients. It's because of bias. It's because of worse care given to racialized people over white people. But if we think about that compounding, if we think about it intersectionally, that compounding, what if we have, so we have a fat patient, which is already treated terribly in healthcare. And we have a fat and black patient who is, you know, black people already treated terribly in healthcare. So, and then you have two compounding identities there, fat and black. What if they're also disabled? Another compounding identity for worse care. So I wonder if how many of these studies, all of these studies that we've been talking about, how many of them have been done predominantly on white people? Probably most of them. How many have compared outcomes between different groups? Not a lot of them. And so we can assume due to racism, due to other systems of oppression that affect other marginalized groups, that the outcomes that we're seeing are the kind of best of the best for white folks. And if we drill down to look at the data on marginalized groups, then the data is probably going to be even worse. So something to think about is informed consent. Informed consent is the idea that you have to give information to patients so that they can make a decision with all of the knowledge, all of the information, so that they can make a balanced decision. And healthcare providers have to do this. So if a surgeon is like, "Yeah, yeah, yeah, you know, this surgery is great, it was amazing. Do you want to meet Cathy over there? She lost 7,000 pounds." And then just says, "Oh, sometimes, you know, there's a risk of death, but don't worry about that. I've never killed a patient." That's not informed consent. Informed consent is saying, "By the way, by year 12, there's a 90% chance that you would only maintain a 10% weight loss." By the way, and that laid out all of the facts. So most patients I feel are not able to give informed consent because they have not been given information that is free from the bias of the provider. The bias of the provider that says, "I'm in the..." By the way, surgery is one of the most lucrative professions in countries like the US that have, you know, private healthcare. They probably have an idea of who fat people are and what is acceptable to put a fat person through to make them into a thin person. They probably see a lot of fat people who say, "My life is terrible." And then they probably see a lot of fat people who say afterwards in the short term, "My life is great." And they are not concerning themselves with that long-term data because it's a confirmation bias. Everything I've seen as a healthcare provider tells me that fat people are sad. I make them happy with this surgery and improve their health. I probably make them live longer. I'm doing a good thing. And it's harder to say, especially if this is your career, can you imagine you've had a career doing this to say, "Look at other data and realize that you maybe you're doing the wrong thing." That's probably intolerable for a lot of people. Can you imagine to realize that you thought that you were doing something good and you're actually maybe harming? It would be really, really difficult, really, really difficult. This one study says, "Commentary raises ethical issues surrounding surgery, including informed consent, patient expectations, long-term follow-up obligation and a variety of outcomes." Something to ask if you are talking to someone who does the surgery. I mean, what's the chances? How long do you follow your patients? What are the long-term statistics? People who do this surgery, they will genuinely have lots of stories to draw from where they say, "I've changed this person's life. I did such a wonderful thing." Because that's what they're seeing short-term. Do they have stories for long-term? Do they have testimonies from people who've had negative outcomes, lifelong side effects, death, as well as positive outcomes? No, of course not. To be able to give informed consent, the healthcare provider would be needing to tell you that, "We're going to be putting your body, your digestive system into a diseased state. We don't have long-term data on outcomes. This is kind of an experimental surgery even though we've been doing it for a long time, but we just don't have the data on it on how it happens. But what we do know is that people lose weight to begin with and their health might improve, but then weight starts to come back on and then health goes back or even gets worse than before. There's a risk of complications. They include this list of 60 things. That one that I read out yesterday, like rectal bleeding and foul odor and cancer and la, la, la, la. Some of these things are not reversible even if we are able to reverse the surgery. It's going to be really expensive because you're going to... Maybe you have to pay for the surgery, you might have to pay for revisions, and then you might have to pay for to have loose skin removed and your body remodeled. Even if you did none of that, then it's going to cost lots of money in vitamin supplements every single month. You may still experience weight stigma because you are probably not ever going to be a straight size person, but you're going to be a smaller fat person. You could probably engage in health promoting behaviors and have the same outcomes or even better outcomes than doing this. Here's a list of weight neutral places that you can go to to look at as well as consider this surgery. That is what they should be sharing when they're talking about the outcomes of the surgery, as well as saying, "Oh, you could lose weight, and you could be great."
Imagine if a healthcare provider did say that. Well, not just a healthcare provider, but a weight loss surgeon who you know it's in their interest to sell you this surgery. You'd probably have increased trust, right? But also, I wonder too, I wonder if you'd be like, "Oh, they're just trying to put me off," or something, and then seek out someone who says, "Everything's great." But then, ethically, you've done your job. Ethically, you've told people the outcomes. Okay. Last section, children. It's fucked up. Okay, so from Aubrey Gordon, her book, "When dieting and lifestyle changes fail as they so frequently do, some parents opt for weight loss surgery for their kids. Centers like Children's National Hospital provide gastric sleeve and gastric bypass to children and adolescents. That hospital doesn't list age limits on its pediatric weight loss surgeries. Eligible kids and teens, they say, have BMIs in the O-range category for at least three years and "understand the lifelong dietary commitment required after the surgery." Children cannot do that. Children's brains cannot understand. Well, you know, they might be able to understand, but they can't understand and have the capacity to consent to this. Anyway, a 2013 case study discussed weight loss surgery on the youngest patient to date. Okay, so what do you think is the youngest patient who has had weight loss surgery? Tell me your number. Shout it out. What is the youngest patient? I'm going to tell you now. A two and a half year old child, baby, toddler. Two and a half years old. It's just, can you imagine? What could a two and a half year old have done to have deserved... No one deserves more than a two and a half year old having weight loss surgery? The American Academy of Pediatrics made recommendations for these surgeries for kids age 13 and up. So this is something that's happened in the last couple of years. The American Academy of Pediatrics, you might have seen this in the last couple of years. People saying, "What the fuck?" They said kids 13 years and up, based on studies that showed only 161 total subjects. So you remember I said, you know, we need more people to know if the data is good. American Academy of Pediatrics have just used studies totaling. So there's not one study with 161 total. They've used varying studies, with subjects like, you know, seven subjects here and 23 subjects there and, you know, with 101 total subjects. So that's like a big clue of, is this data good? The longest follow-up was "five plus years" and the studies consistently showed weight regain that was trending up when follow-up ended. Huh. Surprise, surprise. As well as high rates of additional surgeries and nutrient deficiencies. Imagine a child with nutrient deficiencies. These issues including, and especially nutritional defects can create serious lifelong issues that have not been studied exactly. Thank you, Reagan. So they're the American Academy of Pediatrics report, which is huge, like a hundred pages, citing all of these studies. And again, in the hopes that, I don't know if you're in the hopes of but, people don't look at the studies, they just say, "Okay, well, sounds right." Like a little overview of some of the studies. So there's one study, which was with 81 people, the average weight loss was 36.8 kilograms, which is 81 pounds or yeah, 81 pounds over five years. So that's 16.2 pounds over five years. But you know, we don't, we know that people don't lose exactly that much every month. They did lose more at the beginning.
11% lost 10% body weight, which is a minimal response. 25% of these children required additional surgery. 72% had nutrient deficiencies by year five. Think about this, they're in a study where they know, you know, we're monitoring these children and we know that one of the outcomes is nutrients deficiencies. And still, so would lead you to believe that they are on top of this. Still, 72% of the children had nutrient deficiencies by year five. By year two, weight began to climb. Surprise, surprise. Another study, there was 29% weight loss at year two and 23% required repeat surgeries. Another surgery looked at 50 people and the ,overall trend was weight regain. Another surgery on gastric bands shows that there was worse long-term effects and high complication rates. And with all of these, there's no predictor identified for sustained quote success. It's like a crapshoot of what's going to happen to your child. And again, they were looking at health, they were focused on the studies that they included in that report didn't look at health outcomes, they only looked at weight. And in fact, the studies that looked at health outcomes were excluded. And most of the studies were around 12 months, but what they're proposing is a lifelong treatment. In a child, something you can't, if they are amputating most of your stomach, you can't get that back. And a lot of the authors are linked to drugs, surgery manufacturers. There's just so many ethical red flags. All of this, all of this, all of this. You know, I feel uncomfortable when people do things like pierce their kids' ears. Because I think, well, you're not, you know, modifying your child's body for this reason, you know, your preference and how are they going to feel about that when they're older? And you know, most kids would probably say, I like my ears pierced, whatever. But you know, that's what I think about that stuff. And imagine doing that because obviously these parents have been told, your kid is fucking fat, you need to do something, if you don't, you're a bad parent. Or maybe there might be as well some parents who were just pieces of shit, who were like, I don't want a fat kid, so this is the right thing to do. I think, you know, most of them are probably trying to do their best. Ugh. It's so depressing. I'm sorry, this is so depressing. I'm ending on like, well, all of it is just eye rolling and you know, sucks. Sucks. Boo. But I wonder how many people are, how many people are still, how many people are doing surgery now that GLPs are out? TLDR and GLPs, they too don't work long term. And the substantial weight loss isn't substantial. Again, whatever you do to decide to fight anti-fatness, whether that be to take drugs, to do surgery, to choose not to do those things, whatever you do to survive in this fucked up world is down to you, right? It's your decision and doesn't make you morally superior or inferior or anything like that. The fight is with this society. Remember the analogy of the casino manager looking down and just, you know, rubbing his hands in glee watching all of us down here. And you know, my fight is with that guy. Our fight is with that guy, not everyone else scrambling on that pyramid of sand trying to get to the top, trying to survive. We're in it together. It's like, you know, when poor people vote against their interests, poor people vote for Trump and many are like, I don't understand. How can you do that? And I watched this interesting video that highlighted the fact that they, because a lot of poor people who are white identify more with a white billionaire because they feel like they are in the same group because they're both white. Therefore, they have more in common with them versus the white billionaire versus their colleague who happens to be an immigrant or a woman or someone who's racialized. They're not in the same group. And then that proximity to power. If I vote in Trump, that power of whiteness is going to come to me because I'm a white person and I'm simping to Trump and conservatives and I'm going to benefit from that. And it doesn't make logical sense because those leaders are not thinking about that poor white person in a rural community in
America being like, yeah, he's my bestie.
I'm going to make things better for him because that white billionaire, his bestie is another white billionaire and he's going to make things better for the white billionaire. And we are all just, you know, at the bottom quote unquote, fighting among ourselves saying it's your fault. No, it's your fault. It's your fault. And the casino manager is like, yeah, keep going. You keep going. And so with this podcast, I'm highlighting that casino bosses said here's a surgery for you to get to the top. And it's a distraction. It's a distraction. That's so funny that I said this sandalogy. I started watching. That show, there's a show. I love these shows. What's it called? Physical 100. And then there's a new version of it on Netflix, which is it's a, it's a Korean show where they have athletes do tasks and the show, there's a new series where it's different countries. And so they're fighting against, not fighting, but you know, they're competing against each other. And the first task involved a Hill of Sand. My brain was like Hill of Sand. So, you know, it's pretty, it's pretty epic. I really like those things. I can't watch what I like watching those strong man things when I was a kid, you know, where they'd lift big whole boulders and stuff like that. I'd watch that as a kid. And I'd be like, yeah, go on Eddie. One of the guys names was Eddie, wasn't it? I really liked those things. I'm so impressed about how, you know, the people who are the, have skills in certain areas, how their bodies are all so different, right? And there's this video I was watching last night, which is not related to this, which is the guy who has the, who is the fittest man recorded on earth who has, basically they measure his, when he's breathing, I think this is how much oxygen he has in his breath, like how difficult it is for him to, to work out. And this guy looks like just an average guy on the street. He's not muscly. He's not, you know, you would never, you would never consider, you know, what we would consider a fit person. He's just a guy and he's the quote fittest in this, in this capacity in the world. And he's like a, just triathlons and stuff. And as well, they say there was a YouTuber was going to his training facility and doing a day in the life. And the YouTuber was like, I think the YouTuber is a little bit into diet culture, but doesn't talk about it in the YouTube channel. The thing is, he's called Magnus Miklo. He goes to the training facility and they have lunch and the lunch is he says, I'm so surprised by the lunch. I thought they'd be, you know, salads and all this fancy food, but it was like they had some pasta and bread and it's pasta sauce and you know, whatever, because I'm assuming he has the idea that an elite athlete, I think he's an Olympian, this guy is eating organic grains and the whisper of a mushroom hat found on the Hill of this far away land and you know, this wellness nonsense, but you know, all they have all these coaches and everything around and they're just eating just food, you know, just food, not this restrictive diet that wellness people tell us that is wellness. And as well, and he was like, another meal was a jar of Nutella and bread. And again, the YouTuber was like, what? Like, as if to say, this cannot be what is quote healthy. And I just loved seeing, I loved seeing that.
I loved seeing that. Yeah. And I love seeing the a lot of times the guys who are slim, straight sized, small, incredibly strong. And that's like disrupting with the idea of, of masculinity and the idea that real men warriors are six foot seven and really muscly and all of this stuff. When, you know, the winner of the first season was just this, you know, just another, just a guy, you know, but just happened to be incredibly strong. And these guys that are incredibly strong and, you know, people of all genders, it's just, it's just genetics. It's just the way and obviously they've worked really, really hard, but they have a genetic advantage as well. That makes me think about trans people in sports, you know, this whole world, they have a genetic advantage. It's not fair. Many people and, um, and, um, there's so many different ways that people can have genetic advantages, but we, when, when trans people go into sports, uh, uh, they have their, uh, uh, their hormones levels monitored and so they can't have hormones over the certain range and blah, blah, blah. So they don't have that, that genetic advantage. You might say, well, I have their genetic advantage of being taller or whatever. Every athlete has some type of advantage that means that they are better in some way, you know? So should we exclude someone like this guy who has this genetic advantage that he is able to run this he's, he's got the fastest triathlon time ever recorded in the world. He did it in something like six hours. And there was this, this, this famous YouTuber who's like, I'm so fit and I'm so muscly and blah, blah, blah. And his time was 11 hours in comparison. So, so should we then say, okay, well, we have to genetically test everyone to make sure that they have no genetic advantages, hat they're all exact, that the exact same height, they all have the exact same hormone levels. They all have the exact same training, whatever. There's, there's, there's differences with, with everyone and some people are genetically in voltage in some ways and in other ways and blah, blah, blah. Anyway, I'm going, I'm going totally off tangent, but you know, there's some things I was thinking in my brain that I thought I'd tell you. Okay. I'm going to stop because holy shit, I've been going for 90 minutes. If you appreciate this mammoth research that I've done, then feel free to donate to Ko-fi, link in the description. If not, feel free to write a review. If not, feel free to just have an amazing day. Remember you are worthy. You always were. You always will be. Stay fierce, fatty. Goodbye from me. Bye.