by, for and about Women of Size and their allies

Archive for the ‘surgery’ Category

New Year’s Revolutions: 5 things to do, 5 people to remember

The following is stolen in its entirety from SF weekly. I’m sure Marilyn won’t mind and I don’t really care what the weekly thinks.


Five Things to Do in 2012 That Aren’t
Radical Weight-Loss Surgery

By Marilyn Wann Tue., Jan. 3 2012 at 8:30 AM
photographer: Mark Richards
model: Marilyn Wann
​An acquaintance traveled to Los Angeles recently and saw the ubiquitous 1-800-GET-THIN billboards. “It was like, ‘Welcome to LA … You’re fat!'” said Jennifer Yendes.


The U.S. Food and Drug Administrationtook note of the notorious billboards in early December. Regulators officially told marketing company 1-800-GET-THIN (and the eight clinics that take patient referrals from the ad campaign) that their ads do not adequately warn people about the risks of lap band surgery. They also found the billboards’ existing warnings too small to be legible.

This is the same FDA that in February approved use of the gastric girdle (aka lap band) at lower weights, making major surgery available to people whose clothing tags carry more than one X rating.

The promoters of stomach cinching (aka lap band) were given 15 days to respond or face monetary penalties and possible inventory seizure. The legal representative of 1-800-GET-THIN (who’s been cited in news reports as saying he is also president and CEO of the company) has said the ads will change, and one news report says a new warning has been placed on the company’s website.

The very idea of surgery of this nature reminds me of the bureaucrat’s mother in Terry Gilliam’s brilliant movie, Brazil. She pursues increasingly grotesque surgeries for her looks while increasingly menacing conduit tubes snake through the scenery. Is this really how we pursue health and beauty in our lives and in our landscapes?

Amid what seems like black comedy, I don’t want us to forget the five people who drove past 1-800-GET-THIN billboards in the LA area, underwent lap band surgery, and died.

Willie Brooks was a 35-year-old substitute school custodian. He was 5’6″ and weighed about 300 pounds. According to Los Angeles Times reports, he hoped that if he lost weight, he could get a permanent position. He went on a fishing trip with his wife, Okema, and their six children (then ages 14 to 20) the day before his June 5, 2009, lap band surgery. He died from peritonitis three days after the surgery.

Ana Renteria was a 33-year-old office worker who weighed 240 pounds. She was in constant pain after having lap band surgery in February, 2010, according to Los Angeles Times reports. Her surgeon told her that was how it would feel, her sister Noemi Luna recalled. Ten days post-surgery, she was dead from infection.

Laura Faitro was 50 years old, the primary caretaker for her blind husband living with chronic illnesses. She died five days after having lap band surgery on July 21, 2010. Doctors who treated her after the surgery found she had sepsis. “Faitro’s death certificate lists heart failure as the cause of death, with liver laceration and morbid obesity as contributing factors,” the Los Angeles Times reports.

Tamara Walter wanted to lose 50 pounds. She was a 52-year-old grocery store supervisor and a new grandmother. She had just bought a new house and had plans for travel and a new car. She had lap band surgery in late December, 2010, and entered cardiorespiratory arrest on the operating table. Her family discontinuled life support the day after Christmas, the Los Angeles Times reported.

Paula Rojeski was 55 when she had lap band surgery on Sept. 8, 2011. Surgery clinic workers called 911 and paramedics found her unconscious, not breathing, and with no pulse. She was pronounced dead at a nearby hospital, according to the Los Angeles Times report. It quotes her best friend Marni Rader, who said, “She was never married. She never had kids. Her dogs were her kids. That was her happiest moment, in the park with her dogs. She loved her dogs as much as she loved her family and friends.” Rojeski’s driver’s license listed her height as 5’5″ and Rader estimated she weighed 180 pounds.

I’m no medical authority, but if you’re looking for something fabulous to do for yourself in 2012, here are five suggestions that don’t involve risking death with lap band surgery, things I bet Willie, Ana, Laura, Tamara, and Paula would have liked to do a bit longer.

1. Go fishing. Take a friend or some family members along.
2. Go shopping. And have a leisurely lunch with your sister or your BFF.
3. Spend some time with someone who’s ill. They would appreciate the company.
4. Take your dog for a walk. Play fetch in the park. (No pets? Join a
friend when they walk their dog.)
5. Babysit your grandchild. Or plan an adventurous family outing.

Marilyn Wann has created something fabulous to do for yourself that
doesn’t involve lap band surgery — the 2012 FAT!SO? Dayplanner.

Diagnosis: Bigotry

Weight and Obesity: Discrimination from Doctors

When Your Doctor Makes You Feel Fat
Overweight women are often given a biased diagnosis because of appearance. Here’s how to make sure you get the health care–and respect–you deserve.

By Harriet Brown


When Anna Guest-Jelley–26 years old at the time–badly twisted her ankle, the Nashville native went to see her doctor. “Your ankle’s probably swollen,” she said, “because you’re carrying extra weight.”


Guest-Jelley, a yoga teacher, went along with her diagnosis. When the doctor reported that Guest-Jelley’s x-ray didn’t show any fractures, she returned home with instructions to ice her foot–and an all-too-familiar feeling of humiliation at the physician’s focus on her size. “Almost every time I’ve ever gone to a doctor’s appointment, I’ve experienced some level of shaming because of my weight,” she says.


Her experience is shockingly common. Weight stigma is on the rise in America, according to the Rudd Center for Food Policy and Obesity at Yale University, and, ironically, nowhere is it more deeply rooted than among health care providers. Multiple studies have found that doctors, med students, nurses, dietitians, and other health care professionals routinely stereotype their heavy patients. In landmark 2003 research from the University of Pennsylvania, for instance, more than half of the 620 primary-care doctors surveyed characterized their obese patients as “awkward,” “unattractive,” “ugly,” and “noncompliant”–the latter meaning that they wouldn’t follow recommendations. More than one-third of the physicians regarded obese individuals as “weak willed,” “sloppy,” and “lazy.”


And it’s women who bear the brunt of this characterization–even when they’re not obese. Doctors’ weight prejudices start when a female patient is as little as 13 pounds overweight–meaning her body mass index would likely be around 27–found a 2007 study from Yale University. (BMI is a measurement that uses a ratio of height to weight to categorize people as being of normal weight [18.5 to 24.9], overweight [25 to 29.9], or obese [30+].) “For men, the bias doesn’t kick in until around a BMI of thirty-five, approximately seventy-five pounds overweight,” says Rebecca Puhl, PhD, director of Research and Weight Initiatives at the Rudd Center. “That’s a definite gender difference.”


This bias can have a dramatic effect on women’s health, resulting in incorrect assessments of a patient’s condition and questionable recommendations. It’s impossible to know today whether Guest-Jelley’s doctor, presuming that her patient’s BMI (which was then 38.6) was responsible for her ankle pain, did not read the x-ray as carefully as she might have. But after a few weeks of icing her ankle, Guest-Jelley returned to the doctor because her condition was getting worse. Once more, the doctor focused on the scale. “She told me about how her friend had gone on Weight Watchers and had lost all this weight,” remembers Guest-Jelley. “And I said to her, ‘I’ve been on Weight Watchers five times.’ ”


At Guest-Jelley’s request, the doctor reluctantly referred her to an orthopedic specialist–who took another x-ray and told her that her ankle had been broken all along. Since the fracture hadn’t been recognized and properly treated for so many weeks, Guest-Jelley’s ankle never properly healed.


“I hear so many stories of doctors making assumptions about patients’ health and lifestyles based on their appearance,” says Arya Sharma, MD, PhD, chair of obesity research and management at the University of Alberta. “One of the key factors underlying this stereotyping is the notion that nobody would be obese if they were eating healthy and exercising,” Dr. Sharma says. “But for every obese person I see who doesn’t exercise two hours a day or who’s drinking gallons of soda pop, I’ll treat ten thin people doing exactly the same thing.”


Many women find that, no matter what their symptoms are, their physicians blame their weight. Take Parker Ross, 21, an avid walker and bicyclist who’s had asthma since childhood. Last year Ross, who weighs about 300 pounds, lost her health insurance and went without medication for a year. When her asthma got so bad that she couldn’t walk around the block, she saw a doctor. “I found myself being told that ‘obviously’ my weight was the big problem, and I should try to get some exercise,” says Ross. Although she explained that she couldn’t breathe well enough to exercise, the doctor refused to prescribe new asthma medication and instead wrote a prescription for Zoloft–surmising that she must be too depressed to focus on weight loss or exercise. “Everything I was trying to say to her was being just completely erased by her perception of my fat,” says Ross. “Who I was simply got erased.”


Fortunately, Ross has since found another doctor to treat her asthma.


Mary Tretola, 52, a CPA and a mother of two who lives in Seaford, NY, had a similar experience with her doctor. Since her mid-20s, she’s had a circulation condition that makes her legs swell. “Maybe being overweight does strain my legs, but even back when I weighed sixty pounds less than I do now, I still had this problem,” points out Tretola.


Heart Attack Risks Doctors Often Miss


In some cases, overweight women may be refused medical treatment altogether. Liv Linhares, now a 350-pound 35-year-old social worker in Portland, OR, vividly remembers going to her student health center in college for a routine pelvic exam. At the end, the doctor said, “Because of your obesity, I can’t accurately feel your ovaries, so I can’t tell if there are any concerns.” He asked the then-20-year-old Linhares to sign a waiver saying that if she did turn out to have cancer, the health center wasn’t responsible. Linhares was mortified–and terror stricken. “I thought, Oh my God, I could have cancer and not know it!” she remembers. “He didn’t ask me anything about my life, how I ate, whether I exercised, if I smoked or had unprotected sex–no other questions about my overall health.” Too unsure of herself to speak up, she simply never returned to her health center.


This reluctance to seek medical care is an understandable response, but it can be deadly. “Obese women go less frequently for Pap tests than their thinner counterparts because of the prejudice they run into,” says Joseph Majdan, MD, a cardiologist at Jefferson Medical College who has written about how he himself was stigmatized by fellow doctors before he lost 100 pounds. Research shows that obese women typically get fewer screenings for breast and colorectal cancer too. This finding is especially chilling given the fact that women with BMIs of 30-plus are more likely to die from certain cancers–endometrial, esophageal, and kidney, among them–according to a study of more than 1 million women in the United Kingdom.


Doctors, of course, are expected to rise above social prejudices and treat all their patients with compassion. But physicians’ behavior often mirrors the broader culture’s attitudes. “As a society, we value thinness and hard work, so we equate being fat with being lazy,” says Mary Margaret Huizinga, MD, an assistant professor of medicine at Johns Hopkins University. Although most doctors say they show consideration for everyone they treat, no matter what, her research has found that physicians’ respect clearly diminishes as a patient’s BMI goes up. “Till society changes, the medical profession won’t either,” she says.


Health Test Secrets Doctors Don’t Tell You


Many doctors argue that, overall, they do a good job of attending to all their patients equally. Indeed, a 2010 University of Pennsylvania study established that despite the clear weight bias among doctors, they recommended the same treatments for a specific list of conditions–including diabetes and certain cancer screenings–regardless of a patient’s size or BMI. However, the study didn’t consider other complaints associated with obesity (such as joint pain and shortness of breath), and it looked mostly at older men, who are less likely to experience weight bias.


What’s more, the study didn’t examine whether there was any difference in the way physicians communicated medical recommendations to their patients of different weights–and that may be just as key. “One of the most important parts of the medical relationship is the patient feeling able to ask questions and being comfortable with the doctor’s advice,” notes Dr. Huizinga.


Treating obesity, however, is uniquely challenging. Ninety-five percent of people who lose weight gain it back within 3 to 5 years–which may leave physicians feeling frustrated and helpless and perhaps inclined to blame patients. “When a person has cancer that recurs, the physician is so empathetic,” Dr. Sharma says. “But when a person regains weight, the response is disgust. And that’s morally and professionally abhorrent.”


When doctors take courses that emphasize “uncontrollable” causes of obesity, such as genetics or certain medications, their weight bias diminishes. But, although medical school curricula are expanding, most physicians who are practicing today received little training on weight issues.


Patient advocacy groups such as the Association for Size Diversity and Health and the National Association to Advance Fat Acceptance argue that since obesity has been so stigmatized and is so difficult to treat, doctors should be taught to focus less on weight itself and more on other indicators of health, pointing out that even overweight people can be otherwise healthy. They cite studies like the one published in the Journal of the American Medical Association in 2005 that found that people considered overweight (with BMIs of 25 to 29.9) actually had lower mortality rates than those viewed as being of normal weight. And some advocates also feel that whether weight is mentioned at all should be up to the patient.


But there are also doctors who are strongly committed to avoiding the pitfalls of obesity prejudice–while still addressing weight head-on. “The first thing that comes out of your mouth when you meet a patient can’t be ‘You’re obese,’ ” says Juan Rivera, MD, a preventive cardiologist and an assistant professor at Miami School of Medicine.


“You have to wait for the right moment, and be prepared to work together for a long time. Fighting obesity is a marathon, not a sprint.” Above all, Dr. Rivera says, it takes sensitive, honest communication.


For women who feel that their doctors treat them with less dignity due to their weight, experts, including Dr. Rivera, advise telling the physicians, calmly, what they perceive as biased behavior and how they feel about it. “Ultimately, both parties will benefit,” says Dr. Rivera. “And if your physician doesn’t take the criticism well, it might be a good time to switch doctors.”


Finding a new provider can make a world of difference. After Tretola’s doctor dismissed her swollen legs, she scheduled a physical with a new practitioner. “The doctor asked if I wanted to be weighed, and I said, ‘I’d prefer not to today,’ ” Tretola reports. “That was fine with him. We did talk about weight, but he was very welcoming, not judgmental, and he discussed problems–such as my high cholesterol–without blaming my weight.


“It was so refreshing.”


More Medical lies and untold dangers of Weight-loss Surgeries

Marilyn Wann
[Trigger warning: Binge eating/eating disorders.]
I suspect the very reason surgeons think it’s a good idea to inflict stomach amputation or stomach binding on humans — the assumption that people need to be “controlled” around eating — is part of the reason *not* to do such surgeries!

Swinging from one extreme to the other, those who underwent bariatric surgery might be at higher risk for eating disorders.
I’ve included the link to abcnews article and attribution to the articles original author. But I’ve also included the whole article (reprinted here without permission) because things go missing from links –particularly in high traffic news servers. If I get around to it, I may get permission and update this appropriately… but likely as not… um, not.
One of the most telling things in the article was the author’s honest assessment that one of her interview subjects had a heartattack due to “yo-yo dieting” rather than weight. Also that there is under-reported mortality rate associated with these surgeries. However I take issue with two assumptions. One: the language that says the problem is one of the patient’s “relationship with food”, rather than body image or body hating culture. Two: the blame that is implied for disorders is clearly on the “patients”; ie they lie to pass psych screens and then continue their disgusting Binging and Vomiting even though it puts their lives at risk.
Note the very little comment that the problems are similar to those associated with the surgery. I’ve seen strokes, one bite of food leading to hours of vomiting.

June 13, 2011


Weight-loss surgery was supposed to be Chevese Turner’s salvation — a last resort in her battle against obesity and binge eating. Instead, her 2007 lap band procedure catapulted her into full-blown bulimia.

“I had always struggled with binge eating, and my relationships with food didn’t change just because of the lap band. Even though binging is really painful when your stomach is restricted like that, I would still binge knowing that I would throw it up. I felt like finally I could be bulimic, like this was what I wanted all along,” says Turner, 43, of Soverna Park, Md.

Turner knew she had a binge eating disorder going into surgery, but after experiencing cardiac complications attributed to a lifetime of yo-yo dieting, she was desperate to lose weight. Instead of solving her overeating problem, however, the surgery only changed its form: for 18 months following the surgery Turner regularly binged and purged.

Only after going into intensive therapy to cope with the binging behavior she had experienced since age 5 did Turner, who now runs the Binge Eating Disorder Association, build a healthy relationship with food and her body.

PHOTO: Anorexic woman looking at herself in mirror
Getty Images
Anorexic woman looking at herself in mirror… View Full Size
Isabelle Caro’s Battle With AnorexiaWatch Video
Teen Begs for Gastric BypassWatch Video
Gastric Bypass Kit Offered OnlineWatch Video
When multiple traditional diet methods fail, weight-loss procedures such as the band are seen as a last hope for getting obese patients to eat more healthfully and lose weight. For an underrecognized minority of patients, however, the surgery only triggers a different kind of disordered eating. For Turner, it was bulimia, for others, it’s anorexia. For one fellow patient in Turner’s community, the anorexia was so severe that it ultimately took his life.

Sixty percent of individuals seeking treatment for obesity have some kind of eating disorder, usually binge eating, according to a 2007 Harvard study. It is these individuals, who already have an unhealthy relationship with food and their bodies, who are at most risk of developing further eating disorders post-surgery, says Lisa Lilenfeld, a psychologist and president of the Eating Disorders Coalition at Argosy University in Washington, D.C.

Lap band or gastric bypass surgery is not likely to create an eating disorder where there wasn’t one, she explains, but “the most likely thing is that people had untreated or unsuccessfully treated binge eating disorders before surgery will continue to have problems after surgery. The problem is, it becomes physically challenging and potentially dangerous to binge like this because of the structural changes in the stomach,” she says.

On the other end of the spectrum, patients who used to overeat now overshoot with their weight loss, severely limiting their caloric intake to the point of malnutrition and anorexia.

“I’ve had a number of patients go from very obese to very underweight, so much so that they need to be rehabilitated with intravenous nutrition,” says Dr. Donald Kirby, a gastroenterologist at the Cleveland Clinic who treats patients undergoing bariatric weight-loss surgery.

Because there are so no statistics on how many of these patients experience eating disorders post-op, it’s difficult to gauge the scope of this issue and there is much debate over its prevalence between the surgeons who perform the procedures and the therapists who treat eating disorders down the line. Dr. Mitch Roslin, a bariatric surgeon at Lenox Hill Hospital in New York, has performed thousands of bariatric surgeries and he says he only sees one or two cases a year of eating disorders, but psychologist Lilenfeld believes it’s much more common than that.

Binge Eating: Hiding an Eating Disorder

Technically, those with diagnosable eating disorders are not advised to undergo weight-loss procedures, but because each hospital and insurance company has different psychological screening requirements, many patients with mental health problems slip through the cracks.

In some cases, psychological screenings consist of asking only a couple of basic questions that don’t even address eating disorders or mental health concerns, says Dr. Leslie Seppinni, a therapist who specializes in treating obesity. “Then after the surgery, most doctors fail their patients in terms of follow-up. There are some group sessions with other patients, but that’s about it.”

In Turner’s case, however, her health insurance had relatively rigorous requirements for surgery approval, including an eating disorder screening and a letter from her therapist. But for those who are desperate to get the surgery at all costs, she says it’s relatively easy to get around these requirements by answering the questions “right,” as she did.

Because of insufficient screening or deception, Lilenfeld says about a third of all patients who undergo weight-loss procedures are believed to have “severe binge eating disorder” going into surgery, though not all of these patients will go on to develop other eating disorders post-op.

Isabelle Caro’s Battle With AnorexiaWatch Video
Teen Begs for Gastric BypassWatch Video
Gastric Bypass Kit Offered OnlineWatch Video

Anorexia/Bulimia After Surgery: Medical or Emotional?

One of the reasons that true anorexia and bulimia may not be recognized after bariatric surgery is that the symptoms of these eating disorders can mimic some of the expected adverse affects of the surgery.

In the months following surgery, the stomach has to heal and slowly expand, which makes eating difficult and sometimes painful. Patients who eat too much will sometimes throw up because it’s the only way to relieve the pain in their stomach, not because they are compulsively trying to get rid of calories. Similarly, the indigestion, diarrhea and acid reflux that can occur post-op leads some patients to avoid eating altogether just because eating becomes an unpleasant experience. These patients will become malnourished and resemble anorexics, but the psychological aspect of the disorder is not there.

It is important to distinguish between these medical reasons for anorexic/bulimic behavior and true, psychological cases of eating disorders, says Seppinni, who has traveled the country interviewing people about their experience with obesity, weight loss and bariatric surgery. In true cases of eating disorders, it’s about the addiction to overeating getting transmuted into another addiction. For some, they become compulsive exercisers, for others, alcoholics, for still others, anorexics. “You take away the coping strategy they’ve been using all their lives, and the addiction has to go somewhere else,” she says.

The “loss” of binging as a coping strategy was palpable for Turner following her surgery. “I lay in bed and cried for a week because I couldn’t eat. Eating was the way I soothed myself my whole life. As soon as I could binge again, even though it was extremely painful, I did,” she says.