What happened with Al Roker? His ass has gotten about as big as it used to be.
How does one defeat gastric bypass surgery? Eat nonstop? Does the new “pouch” grow large enough for gluttony to become more effective? Wha hoppon?
Interestingly, the rather detailed Wikipedia article makes no mention of any way gastric bypass can be beaten. (It does note that the surgery is hideously dangerous - if I’m reading this correctly, it kills 1 in 50 patients, which is why they only use it for people are are legitimately gigantic.)
However, it does appear that bad eating habits will beat it. Al Roker is one example, but Carnie Wilson is another; she lost a truly staggering amount of weight after gastric bypass but has gained it all back. I feel sorry for them; weight problems are tought to beat. I struggle to keep weight off but I’m not even half Al Roker’s width - I’m four inches taller and I bet he had 150 pounds on me, easy. Losing weight is easier said than done and he’s got a lot more work to do than most people.
Human evolution favored those who could put weight on, not those who could keep it off. That’s the reason losing weight can be so hard - biology is against you. It’s not always a matter of simple gluttony (although that does happen) - poor food choices and lack of exercise are also major factors. An inconsistent day to day schedule, or stress, can also make it harder to lose weight and both TV people (Roker) and musicians (Wilson) tend to have chaotic schedules and stress. Then there are emotional/mental habits that lead a person to eat as comfort, cultural problems (relatives who urge one to finish the plate of food, take seconds or thirds or more, etc.) and other factors that can work against a person.
That doesn’t, to my mind, give anyone a free pass, but you have to realize that losing weight and keeping it off is a lifetime struggle. You’re never really “done” with the project and it’s very hard to keep up the effort every single day of your life.
Yep, for the most part, that’s true. Then you have the case of one of my relatives who was 5’5" and 245 pounds. Pretty significantly overweight by anyone’s standards. I went with this acquaintance to some of her pre-op appointments.
She was–BY FAR–the most “normal” sized person I saw in the lobby each time I went with her. By far. One woman was sorta draped all over a chair that was probably somewhere underneath her. Another person came in on–I guess it was a motorized wheelchair, but it looked more like a motorized gurney–the person being mostly an amorphous blob.
But this relative of mine convinced them that she needed the surgery, and they did it.
Which was paid for by Medicaid.
The type of surgery Roker (and Carnie Wilson, btw) had is called the Roux En Wye (RNY) which can fail in a number of ways. To understand how it can fail, you have to understand a little about the surgery itself.
With the RNY, most of the stomach is sectioned off and stapled, leaving only a tiny pouch. Then an artificial opening (called a stoma) is created at the bottom of the pouch to allow food to go down into the digestive tract. Some RNY’s also involve bypassing some of the intestinal tract to allow for malabsorption of certain nutrients (primarily fat).
The top two ways RNY’s fail: One is that the stoma (tiny to begin with) stretches, so that everything eaten goes directly into the intestines. Therefore, your brain never gets the signal to stop eating because your stomach is never full. The second way is that the “staple line” in the stomach section can be disrupted (one or more of the staples can come out), thereby rendering the stomach capacity what it was prior to surgery. If either of those things happen, it’s easy to see how the weight can be re-gained. The more of the intestine is bypassed, the greater the chances for keeping more weight off. However, removing a great deal of the intestine carries its own risks and implications, and some people want to avoid that. There’s also a lot of misinformation (generally spread by RNY doctors and “surgery mills”) about the horrors of a great deal of malabsorption.
I studied all of this carefully when researching weight loss surgery for myself almost three years ago. These failure problems are primarily why I chose the Duodenal Switch (DS) surgery for myself. With the DS, the stomach is not just stapled off, it’s removed. Therefore, there is no staple line to disrupt. Also, instead of creating a stoma, that part of the stomach is left intact, so I have a functional pyloric valve. Therefore, stoma stretching cannot become an issue for me. Also, with the DS, a lot more intestine is bypassed, and malabsorption plays a huge (heh) roll in the increased odds of keeping off much of the weight lost.
The RNY works beautifully, long term, for a lot of people. There is not a surgical option that works all the time for everyone.
I haven’t read the Wiki article on this, but all the good stats I could find is that, for an experienced bariatric surgeon, the death rate is approx. 1 in 200. Also, legitimate bariatric surgeons will not do the surgery on people who are less than morbidly obese. However, there are plenty of non-legitimate quacks and “surgery mills” out there who will do the surgery on pretty much anyone who has the money to fork over to have it done. 
You would reasonably expect the death rate from these surgeries to be somewhat higher than death rates for other major surgeries (which all carry a mortality rate) because the people who are being operated on are (mostly) at least morbidly obese, frequently super-morbidly obese, and often already have health complications (many insurance companies require substantial health complications before they’ll pay for the surgery; I love that my insurance company is good enough that it took my BMI and mental health into account, and did not require me to wait until I developed diabetes, degenerative joint disease, liver disease and other serious illnesses; the worst I had was borderline-high blood pressure).
I wonder why he chose the gastric bypass over Lap-Banding [just curious]?
On top of this, I’ve also seen Roker on various Food Network specials/shows, and they weren’t the healthy eating ones, either. He has a “Roker on the Road” show which IIRC is mostly “road food” and similar stuff, and you know that eating random stuff from traveling to assignments and then being a good guest at the shoots cannot be “part of a well-balanced diet” without some severe efforts on his part the rest of the time. Top that off with how people who’ve underwent many of these types of procedures are still supposed to severely limit how much food they eat at once, versus the pressures of being on food-related shows and just the conditioning of your brain/your culture/your past/etc., and I can see how he could easily undo everything the surgery had done.
According to most studies, lap-band has a lower expectation of excess weight loss than the gastric bypass does. Here is one cite which backs this up, and keep in mind this is a website that is trying to sell gastric banding! http://www.weightlosssurgery.ca/en/surgicaloptions/comparisonchart.
The death rate is a bit misleading, though; the biggest complicating factors in surgery of any kind generally involve the health of the patient - obesity, heart disease/problems, diabetes, etc.
By its very nature, the people getting gastric bypass surgery are certainly going to have at least one of these risk factors (obesity), and almost certainly a couple more.
I also tend to believe that, in time, as the data comes in for the people who have had these types of surgeries- as this is really the first generation of these types of surgeries, that it will also be shown that in the end, in a great number of the cases, that it will actually result in more premature deaths and serious health problems lowering the quality of life, than would have been caused by the preexisting obesity. I believe electing to have any of these surgeries is foolish, shortsighted, and accelerated death, in most cases more dangerous than the obesity. It’s a ridiculous maiming surgery for vanity.
According to a study in The New England Journal of Medicine, this is not true. Here is a summary of the article, as it appeared in The New York Times:
"August 22, 2007
Weight - Loss Surgery Boosts Survival Rate
By THE ASSOCIATED PRESS
Filed at 9:09 p.m. ET
LOS ANGELES (AP) – The first long-term studies of stomach stapling and other radical obesity treatments show that they not only lead to lasting weight loss but also dramatically improve survival. The results are expected to lead to more such operations, possibly for less severely obese people, too.
Researchers in Sweden and the United States separately found that obese people who underwent drastic surgery had a 30 percent to 40 percent lower risk of dying seven to 10 years later compared with those who did not have such operations.
The research, published in Thursday’s New England Journal of Medicine, should put to rest uncertainties about the benefits and risks of weight-loss surgery and may cause governments and insurers to rethink who should qualify for the procedure, some doctors said.
‘‘It’s going to dispel the notion that bariatric surgery is cosmetic surgery and support the notion that it saves lives,’’ said Dr. Philip Schauer, director of bariatric surgery at the Cleveland Clinic in Ohio, who had no role in the research.
Obesity surgeries have surged in recent years along with global waistlines. In the United States alone, 177,600 operations were performed last year, according to the American Society for Metabolic & Bariatric Surgery. The most common method was gastric bypass, or stomach-stapling surgery, which reduces the stomach to a small walnut-sized pouch and bypasses part of the small intestine where digestion occurs.
The Swedish study is the longest look yet at how obesity surgery affects mortality.
Researchers led by Dr. Lars Sjostrom of Goteborg University compared 4,047 people with a body-mass index over 34 who had one of three types of surgery or received standard diet advice. BMI is a standard measure of height and weight and a BMI over 30 is considered obese.
After a decade, those in the surgery group lost 14 percent to 25 percent of their original weight compared to 2 percent in the other group. Of the 2,010 surgery patients, 101 died. There were 129 deaths in the comparison group of 2,037 people.
In the U.S. study, Ted Adams of the University of Utah led a team that looked at 7,925 severely obese people in the state who had gastric bypass. They were matched with similar people who did not have the operation and who were selected through their driver’s license records listing height and weight.
After an average of seven years’ follow-up, 213 people who had surgery died compared to 321 who did not have the procedure. The study did not look at weight loss.
Deaths from diabetes in the surgery group were dramatically cut by 92 percent; from cancer by 60 percent and from heart disease by 56 percent. Surprisingly, the surgery group had a higher risk of death from accidents, suicides and other causes not related to disease. The researchers were puzzled by this.
Both studies were done before surgery advances that have led to smaller incisions and faster recovery time. Experts say future long-term survival rates from obesity surgery should be even better.
While neither study was the gold standard test, where patients are randomly given one treatment or another, surgery’s dramatic benefits make it ethically hard to deny patients the operation, said Dr. George Bray of the Pennington Biomedical Research Center at Louisiana State University.
Herb Olitsky, a 53-year-old business owner from New York City, credits his improved lifestyle to gastric bypass.
A diabetic, Olitsky was given months to live after developing a life-threatening bacterial infection near his heart muscles.
Olitsky, who stands 5 feet 8 inches, underwent stomach-stapling surgery in 1999 and went from 520 pounds to his current weight of 160. He no longer struggles to walk a quarter block and has managed to control his blood pressure and heart rate.
‘‘I knew I had to get it and that’s what’s kept me alive,’’ Olitsky said. ‘‘I’m healthier now than I’ve ever been.’’
More than 400 million people worldwide are obese and surgery is the only proven method to shed significant pounds in a short time. In the United States, it costs $17,000 to $35,000 and insurance coverage varies.
Weight-loss surgery is considered relatively safe with the risk of death from the surgery at less than 1 percent. Common complications include nutritional deficiency, gallstones and hernia.
U.S. guidelines recommend that surgery be considered only after traditional ways to slim down have failed. Candidates must be at least 100 pounds overweight and have a BMI over 40, or a BMI over 35 plus an obesity-related medical condition such as diabetes or high blood pressure.
This fall, a panel of experts from the National Institutes of Health will revisit the obesity surgery guidelines. It’s not yet known whether a BMI change would be considered, said spokeswoman Susan Dambrauskas.
Susan Pisano, a spokeswoman for America’s Health Insurance Plans, which represents 1,300 insurers, said the group will rely on any new recommendations from the federal government."
Don’t look at his ass. It’s not good.
Cook the books, you get what you want… I got Wilson and Roker in the Deathpool.
I think the surgery was misrepresented and oversold to them due to celebrity and commercial access.
Theirs is damaging… and I’d guess at least 20% have damaged and maimed themselves unnecessarily. They aren’t in your report.
Why should these people not have the right to decide not to live as mounds of lard, even if the life they end up with is a little shorter? People already have the right to make their lives shorter in countless ways for less benefit (like drinking and smoking).
Valete,
Vox Imperatoris
Well, if scientific articles in medical journals aren’t going to change your opinion, nothing is, so I’ll stop.
But let me present another viewpoint: let’s say (though I don’t believe it) that people are not lengthening their lives by having this surgery. What if it’s only improving the quality of life that they have left? If someone had told me I could live another 20 years with a BMI of 50 or another 20 years with a BMI of 30, I’d have taken choice two, and I’m guessing I’m not alone. And while I can’t speak for anyone else, my choice to have the surgery was not for vanity. It was for a whole bunch of other reasons.
As for maiming myself, well, I’ve also done that by having my gall bladder removed, having a hysterectomy, and getting my freakin’ ears pierced.
From what I understand Weight loss surgery automatically lowers quality of life by the process, period-- malnourishment and vitamin deficiencies, sugar dumping, excruciating stomach pain, hair thinning, constant diahrrea, anemia, osteoporosis, ulcers, stenosis, gallstones, highly restricted diet. Any of those sound familiar?
And by the way, did you have your gall bladder removed before or after the WLS? Were your gallbladder problems maybe secondary and caused by the WLS?
I’m diligent about my vitamin/mineral supplementation, and my labs (drawn every six months) are fine, thank you for your concern. My hair? Just fine. Again, thanks for the concern. Constant diarrhea? Nope. Well, right now, I’m on antibiotics for a kidney infection (chronic since 15 years of age, non-weight-related) and they are making my bathroom habits a little more frequent. Otherwise, I’m twice in the morning, that’s it. The surgery I had doesn’t “do” dumping. Excruciating stomach pain? For the first few weeks. No worse than what I suffered after having all three of my kids C-section. Highly restricted diet? Lemme see. I eat protein first (always; have to get about 100g a day, not a problem), and I’ve lost my taste for most baked goods. Otherwise, no, not really. In fact, I just finished eating a handful of Pringles.
Gall bladder removal preceded weight loss surgery by approximately 20 years.
Again, your concern is appreciated.
I think devilsknew is mistaking possible side effects for typical experience.
Proper dietary changes and a few inexpensive supplements will either prevent or treat most of those problems in most people. One of the reasons for counseling and pre-op workup is to make sure people understand that they can’t keep on with bad habits after the surgery, they have to make changes.
Agreed. I know a few (minority of) folks who’ve had the DS who’ve had serious complications that could not be resolved without further surgery, and other drastic measures. For a great majority of us who follow the (fairly lenient) rules, and supplement regularly, these problems are simply. . .not a problem.
As for “dumping syndrome”, some people choose the RNY over the DS because they’re “sugar junkies” and actually want the dumping to act as negative reinforcement to them eating sweets non-stop. However, be it fortunate, or unfortunate, dumping only affects about 1/3 of RNY patients (I’m sure I can find a cite for that, if required).
For me, though my desire for sweets hasn’t really disappeared, but my desire for baked goods has pretty much vanished. I couldn’t care less if I never ate another donut again in my life. Also, my body knows that protein is what I need. When I’m hungry, no amount of carbohydrates will satisfy me. I need to eat protein. Period, end of story. In fact, when I’m sick (when most people want toast and applesauce) what do I crave? Tuna salad. Yep. There ya go.
My kidneys suck, have since I was 15. They were a driving factor in the WLS. I have an average of two surgical procedures per year to remove kidney stones. The heavier you are, the riskier general anesthesia is. Being almost 150lbs lighter makes general anesthesia much safer.
OK, time to get off my soap-box and go eat some cheese! 
There are two kinds of eating, eating a lot and constantly. I knew a very obese woman and she never ate much, but I can’t ever recall seeing her without something in her hand.
She’d go to lunch with us have an egg and maybe some salad then go back to work and have one twinkie, then 15 minutes later candy bar. Ten minutes later it was a small bag of chips.
It never was much at once, but she ate constantly. I’m thinking this is how these people regain weight.
Also aren’t most people that get this operation morbidly obese. Wouldn’t that make them more likely to die from any surgery anyway?
I knew one guy who was a surgeon and he told me it wasn’t so much the actual surgery but so many of his patients were so fat, you had to cut through layer and layer and layer of it.