When will bariatric care catch up with the science?

[Trillium 50]

In my experience, the materials given to bariatric patients and "support" from paraprofessionals and insurance company nursing consultants have not caught up to the science. (The welcome brochure from the hospital has a scale indicating "calories in / calories out." Bogus!)

They are still talking about emotional eating and obesity as a failure of self-control. This is not only dated but cruel, and counterproductive. My surgeon is the only one among her staff that is apparently willing/able to discuss the complex mix of genetics, gut microbes, hormones, and obesogenic factors that may underly my BMI. Imagine a breast cancer patient being forced to walk a gauntlet of people who assumed her morally culpable for her DNA, toxic mattress, drinking Water, medications, stress levels, etc, and asked her on every form, in every conversation, "what have you done?" and "what are you doing?" to prevent these cells from invading your body.

This is not trivial, as our ideas about our own obesity appear to be critical to success after surgery:

http://esciencenews.com/articles/2014/10/23/how.people.view.their.own.weight.influences.bariatric.surgery.success

I view my excess weight like it's a cancer, a growth I do not want, did not ask for, and YES, may have encouraged through any number of life choices. (For starters, I should have refused all those antibiotics. I should have been eating anti-inflammatory foods, not low fat, in my crazy youth. I should have married someone who cooked, and moved to a bike-friendly city. So many wrong choices!)

If some day, in spite of our efforts to protect them from cancer and obesity, my children end up seeking treatment, I hope they get it from professionals whose prejudices do not infect their care. Who give them facts, not unsupported ideas, about the best route to health.

Oh, and about all those inflammatory processed bariatric "foods" my clinic is pushing? Don't get me started.

/endrant

[CowgirlJane 14,261]

Well, this is one of the things I like about my bariatric center. For the first time in my life I began to understand obesity as a "disease process" and all the REAL reasons I could not maintain a weight loss without WLS.

I agree with you though, and alot of nutritionalists are freaking clueless. Pre WLs, I went to a nutritionalist who apparently thought I was illiterate and clueless because we played with plastic fake food. Like, if only I really understood the difference between a potato and brocoli. If only I could grasp that 1/2 cup is half of a cup.... then i would clearly have control over my obesity. It was all I could do to refrain from saying "I am fat, not necessarily stupid"

[BigGirlPanties 957]

Wow...that's so sad...guess I'm lucky...I go to a bariatric center of excellence, so they are focused on good eating and understand the genetics of the problem.

My therapist teaches Success Habits and is an addiction counselor AND she had WLS about 10 years ago and is still maintaining... she is PERFECT...love her to pieces!!!

I guess, as always, everyone is different...for once, I am one of the lucky ones

[Brn2blossom 88]

My NUT says what the surgeon wants her to say but then tells you the truth. I love her! I too believe the medical industry is behind the times in obesity but I think it more has to do with insurance companies, prescription drug companies, $$$$, and politics.

[atelux171 7]

I'm postop and I work in healthcare. I can't tell you how many times I have been called a 'cheater' or accused of taking the easy way out after having weight-loss surgery. The stigma is unbelievable. Would my colleagues prefer me debilitated by obesity until I was unable to walk & had a myriad of other health problems? The psych aspect goes largely unaddressed. I liked the point about a breast cancer patient being asked to produce their history & their current attempts to get healthy prior to treatment. Shame is the most harmful human emotion. There needs to be more open & science-based communication.

[Cleo's Mom 257]

I can so identify with what everyone says here. My original lap band surgery was done by an inexperienced general surgeon in 2008 ,who along with his partner, took over a bariatric practice of a retiring surgeon.

I first met with his partner (an emaciated runner - you know the type)and when he asked why I wanted the surgery I said to reduce the chances of cancer . He said you already have cancer (breast cancer dx in 2002 - successfully treated). Wow, what an answer. Especially when there is a lot of scientific evidence to show that weight loss reduces cancer risk for many types of cancer.

I got switched over to the other doctor when his schedule got too busy. The nutritionist that I had to meet for 6 months had an office filled with fake food. All the boxes of lean cuisine, smart choice, etc.. and plastic hamburgers, eggs, etc..to show us what correct food sizes were.

I followed all the rules and lost 60 pounds pre surgery. (I went from 250 to 190). After the band was put in - the surgeon wanted me to lose 10-15 pounds in the next 3 weeks without a fill. FIRST RED FLAG. This showed to me that he had unrealistic expectations about obesity and weight loss.

When I didn't lose this much weight, I got the "Come to Jesus" talk. Then he filled me with 1.5 cc (in a 4cc band - I was told it was a 10cc band). I got stuck with salsibury steak (lean cusine) and he told me to throw that away it was all fat. The nutritionist was there and I said her room is filled with these dinners and they should be on the same page.

Then he overfilled me with 1.5 more cc and when nothing was going down he ordered an upper GI and saw the mess and took the 1.5 cc out. That is when I went to another bariatric surgeon for a second opinion who said: You have a 4cc, not a 10 cc band and your weight loss in 6 months is about what we would expect in a year. However I had a very bad stuck experience in 2009 requiring a trip to the ER where all the fill was removed and that is where I am now.

I don't believe that there are a lot in the bariatric field that know about the genetics of obesity or the role hunger hormones play.

My paternal grandmother who was born in the late 1890's was a big, obese woman of eastern European descent and by all medical standards - obese. I take after her, as did my dad. She was born when there was no processed food, no fast food, people cooked from scratch. This is often blamed for our obesity. Yes, for some. But obesity is a disease and should be treated as such.

We don't blame the victim with other diseases. It should be that way for obesity.

[dbqueen 13]

First of all, thank you to all of you who have posted in this thread thus far! It was so refreshing to find folks who can comment on these issues in such an articulate and intelligent way.

I was totally (and pleasantly) surprised when I went to the "informational seminar" at my surgeon's office near the end of last year. The message was, "obesity is a disease, WLS is a treatment." No blame! As someone with a healthcare background (clinical pharmacist turned biostatistician), I was familiar with this "new way of thinking." That seminar was the first time I had heard any professional providing healthcare for bariatric patients actually articulate the concept. It really blew my mind!

The psychological aspect of this journey toward whole body health is so important! I have worked with several different mental health counselors over the past 20 years. The first three were somewhat helpful but did not have a clue how to address my emotional eating issues, even though that is what I told them I needed to work on. Two years ago, I started working with a clinical psychologist who really "gets it." I wasn't contemplating WLS at the time -- I still thought that I could do it myself with a little help. After six months of biweekly visits, I realized that I did need to have WLS, and then hit a wall with my insurance company.

The insurance company requires that you go through a year of monthly 20 minute phone calls with a nice, but totally clueless, nurse reading questions off a script that did not seem to pertain to preparation for WLS. You also had to participate in Weight Watchers or Jenny Craig for a year. Both my clinical psychologist and I agreed that I was ready NOW, but there was no way to penetrate the bureaucracy to see if a waiver was possible. So I gave in, and endured the stupidity for several months -- until about a year ago. My husband and I decided to move nearer to my family and bought a house in NH in June. I was hoping we would be able to move before the end of 2014, so I would not be "in town" to follow through with the program and have my surgery here in VA. That gave me the excuse I needed to quit the stupid insurance program. I think that's what they wanted in the first place!

When it became apparent that we would not move until April 2015, I looked into the possibility of having a VGS as a self pay patient. Long story short, when I went to see the surgeon in whose "program" I was enrolled about this option, he unceremoniously accused my of "jumping the line" and said that the wait would be good for me -- I could learn better habits. Then he said he would not talk to me further and walked out of the exam room. As he was walking out the door, he said that he would refund my copay. I have never been so humiliated in my entire life! At that point I looked into having the surgery done with the other bariatric group at another local hospital, and the process has gone smoothly -- I had a VGS done on 2/19 and I a recuperating well.

I talked with my clinical psychologist about my interaction with surgeon #1, and she was speechless. She does a lot of the psych evals for patients for both of the local bariatric surgery groups and knows all of the surgeons. She said it was totally out of character, but totally unacceptable. However, Karma gave me a chance to tell surgeon #1 how I felt. I had lower right quadrant pains and was running a bit of a fever and thought I might have appendicitis, so my husband took me to the ER. They admitted me for a couple of days of IV antibiotics for right ascending colitis. While I was in the hospital, the surgeon on call for GI surgery was none other than surgeon #1! By the time he arrived, I was feeling better and I also knew that he would be coming to see me. I was prepared. He said, "You look familiar -- have we met before?" I said, "Yes, I came to see you about self pay WLS a couple of months ago and you kicked me out of your office." He seemed a little stunned and then admitted that he recollected the interaction. No explanations, no apologies, but I feel as if I got my message across. I hope he never does anything like that to another person!

I have been ashamed of my appearance for almost my entire life. After growing up as a "fat kid" I was able to get down to a "normal" weight for about 5 years in my mid to late 20's, but once I got married and my husband started having a lot of health problems, I turned to food for consolation and the rest is history. The hardest part about all of this was that I felt that as a clinical pharmacist, I should have known better and should have been able to get my eating under control. As the years went by, I started developing all of the expected illnesses, hypertension, high cholesterol, asthma and a boatload of allergies, depression, and sleep apnea. The thing that lit a fire under me last fall (other than feeling that I was in fact ready and could afford the self pay option) was that my HgA1c's were starting to creep above normal and my BP was no longer controlled by 3 meds. The fact that I knew we'd be moving in April and I did not want to have to go through the whole approval process in a new location weighed on me as well.

I think I have gone on long enough in this post -- I hope it hasn't been "TMI." Thanks for listening, and I look forward to hearing what you have to say!

[Cleo's Mom 257]

dbqueen - thank you for sharing. I found your post very interesting and not long at all. I like to read other people's stories. We all got to this point in our lives for different reasons. I suspect that in addition to being a volume eater (it takes a lot of food for me to reach satiety) I am also an emotional eater (later in my life - I am 64).

But my story is different. I was a skinny kid, a skinny teen (116 lbs at 5'5") and 122 lbs at marriage at age 22. I never thought about food. I ate when I was hungry. Stopped when full and stayed skinny. But in my late 20's I started putting on some weight and panicked and joined Weight Watchers and that's when the dieting - and yo yo dieting started and here I am at 64 having dieted for over 30 years and contemplating my SECOND weight loss surgery.

When I started to put on weight in my 20's it was like a switch was flipped. And the genes took over. Both parents, brother, 3 of 4 grandparents, maternal aunt, all three of her kids - all obese. Some of these people were thin at one point - others obese almost from birth. And the one daughter of my obese aunt has two adult kids - a thin boy and a daughter who is her clone and has been obese almost from birth. I am the 4th person in my family to have WLS. On my dad's side - his brother had 4 kids. My dad's brother was short and not overweight. 3 of his 4 kids were normal weight. The last one - a girl - got the paternal grandmother genes (who I mentioned previously) and was obese her whole life - and had gastric bypass many years ago.

There is no way to look at my family and not see the gene impact.

However, I have not discounted my emotional eating. My husband and I were both diagnosed with cancer 11 months apart and while I have survived mine, he died of his almost 10 years ago. A very stressful time then and now for me. Having to watch my young husband slowly die of this dreadful disease took its toll on me. I still have a lot of anger for what it took from him and me. I am in therapy.

I am so glad you didn't go with surgeon #1 and were able to tell him what he did to you. There are so many in the medical field who really shouldn't be.

Sounds like you are doing well except for the colitis. I think your medical problems will resolve over time.

Good luck with your move.

[geistmadl 1]

I agree. People don't understand people who are overweight aren't overweight because they are lazy. They can have some of the same bad habits a normal sized person has but because of genetics and other factors the predisposed get the brunt of it. People don't get that nor do they get mental health. I personally believe that people view it as not a problem. Education and educating the public is not seen as a problem they do what they can.smh. And whenever they get on the same page it'll be because something tragic has happened and they had to take measures to cover their asses.

[BLERDgirl 6,417]

I think it will take normalizing the surgical process to do that. I didn't have anything remotely like what the OP has in her procure. Both at the seminar and during my meetings with nutritionist & psychologist they talked about emotional eating. Part of what they share in the support groups almost always deals with the external factors that play into weight gain.

[VSGAnn2014 12,992]

Some great comments in this thread. Thank you all.

I was lucky -- had a good surgeon who has a good team.

And several months before surgery I chose to go into therapy with an excellent psychologist who knows the bariatric scene inside and out. I've said this many times, but will say it again: I will be in therapy for three years: (1) the year of losing weight, (2) the year of maintaining weight and (3) the year of boring real life.

First time I've ever been in therapy. But this is the battle of my life. I won't fail this time.

[Cleo's Mom 257]

I also think the surgeons who perform these surgeries need to catch up to obesity research, in many cases. Most, if not all, bariatric surgeons were general surgeons at one point who jumped on the bariatric bandwagon when insurance started paying for these procedures. I'm not sure what extra training they received but I think many of them are undereducated on the factors that result in obesity as well as realistic weight loss goals and weight gain after surgery. Obesity is a disease but is not treated as such by many in the medical profession and certainly not by the media or public. Blame the victim.

[CowgirlJane 14,261]

I am eternally grateful for stumbling across a surgical practice, that you are absolutely right were good surgeons who realized there was money to be made in WLS, BUT who invested in the understanding about obesity.

Those surgeons educated me. One of the most caring things a medical person ever said to me...when I was bawling about what a failure I was at over 300# and the surgeon who removed my band took my hand and said "you know you have a disease process called obesity that drives your hunger and your physical responses. It's not your fault you need surgical help to beat this." I have never felt so respected as a fat woman. ever.

I also think the surgeons who perform these surgeries need to catch up to obesity research, in many cases. Most, if not all, bariatric surgeons were general surgeons at one point who jumped on the bariatric bandwagon when insurance started paying for these procedures. I'm not sure what extra training they received but I think many of them are undereducated on the factors that result in obesity as well as realistic weight loss goals and weight gain after surgery. Obesity is a disease but is not treated as such by many in the medical profession and certainly not by the media or public. Blame the victim.

[purrfctangel 239]

I love this thread. I have dealt with this mentality my whole life and grew so weary of being talked down to while being shown plastic food, many stories similar to yours. I'm so happy to have found my surgeon and this group!

[Cleo's Mom 257]

I love this thread. I have dealt with this mentality my whole life and grew so weary of being talked down to while being shown plastic food, many stories similar to yours. I'm so happy to have found my surgeon and this group!

Ah, the plastic food. I spent 6 months (pre lap band) going to a nutritionist whose office was filled with plastic food and empty boxes of diet dinners. Yes, all it takes is just eating those foods and thinness will be yours! Like we're stupid and haven't tried all of that.