Tuesday, February 06, 2007

Down the Rabbit Hole of WLS for Children

Get ready for our adventure down the rabbit-hole today as we explore the solution to childhood obesity in Wonderland.

The Chicago Tribune reported yesterday, [a]s the popularity of stomach surgery has skyrocketed among obese adults, a growing number of doctors are looking at children as possible candidates.

A group of four hospitals...are starting a large-scale study this spring examining how children respond to various types of weight-loss surgery. They include gastric bypass, in which a pouch is stapled off from the rest of the stomach and connected to the small intestine...[and]...a procedure called laparoscopic gastric banding, where an elastic collar installed around the stomach limits how much someone can eat.

The study was approved by the FDA after surgeons at New York University Medical Center published findings in the Journal of Pediatric Surgery this month. In that study, 53-children, aged 13 to 17, underwent bariatric surgery; they lost nearly half their excess weight over 18-months post-op.

The Chicago Tribune highlighted the "success" of one teen, Crystal Kasprowicz, who shed 100-pounds after the surgery, but didn't mention any of the teens who faced additional surgery or other complications after their surgery.

In the abstract of the study we find some numbers to give us an idea of the complications:
  • 2 patients had band slips that required laparoscopic repositioning
  • 2 patients developed a symptomatic hiatal hernia that required laparoscopic repair
  • 1 patient developed a wound infection requiring incision and drainage
  • So, of 53 subjects, 10% required additional surgery

  • 5 patients experienced hair loss
  • 4 patients experienced iron deficiency
  • 1 patient developed nephrolithiasis and cholelithiasis (kidney stones and gallstones)
  • 1 patient develpped gastroesophageal reflux
  • So, of 53 subjects, 21% experienced a complication that didn't require additional surgery

In total, 30% of all the patients experienced a complication. Funny how the media fails to report that, huh?

When Britain recently approved weight loss surgery for children, I included a list of complications we know happen in adults in UK Solution to Childhood Obesity - Surgery & Drugs:

Short Term Complications (in the first 3 to 14 days)

  • Bleeding Leak
  • Abscess and Infection
  • Pulmonary Embolus Death
  • Severe Nausea and Vomiting
  • Narrowing or ulceration of the connection between the stomach and the small bowel has been reported in one series in about 20% of all patients undergoing gastric bypass
  • Bile Reflux Gastritis occurs when bile flows back into the stomach
  • Fistulas, (an abnormal passage leading from one hollow organ to another) abscess and infection have been seen in gastric bypass operations
  • Dumping Syndrome
  • Gallstones
  • Adhesions, scar tissue caused by healing after surgery
  • Diarrhea

Long Term Complications

  • Vitamin and Mineral Deficiencies - Decreases in iron, vitamin B12, and/or Folate levels were detected eight months to eight years (median, two years) after the operation
  • Peripheral neuropathy (disorders resulting from injury to the peripheral nerves) has been reported after operation
  • Osteoporosis and Bone Loss
  • Gastric bypass procedures carry the highest risk of multiple micronutrient deficiencies, that may supervene despite close medical follow-up
  • Patients with a gastric bypass have a greater frequency of microcytosis and anemia, more frequent subnormal serum levels of vitamin B12, and impressive failure to absorb food vitamin B12
  • Gastrointestinal bleeding from a duodenal ulcer four years after having a gastric bypass procedure for obesity
  • Symptomatic gallstones requiring cholecystectomy
  • Abdominal Wall Hernia
  • Pregnancy Complications

But let's set aside the complications for a moment and read what one surgeon tells his patients (adults) before surgery:

The “two by two” lecture is legendary. After prepping more than 900 patients for bariatric procedures since 1998, Gus Slotman, MD, a School of Osteopathic Medicine (SOM) professor of surgery, can move through his advance warnings for obese patients with lightening speed. “I say this all day long,” he laughs, joking that as a baby boomer himself, his mantra might just be helping him stay as thin as he was back in school.

Without pausing for a single breath, he can rattle off the dietary rules for life after surgery: “Two ounces of protein every two hours, or eight times a day. That’s two by two and take 15 minutes to finish. I tell them they have to commit themselves to eating no more than two ounces at a time. And there will be no room for anything but meat, fish, chicken, vegetables, fruit, dairy products, eggs and other proteins. Say goodbye to bread, potatoes, rice, pasta, noodles, pretzels, chips, cheez doodles, crackers, junk cereal and all those starch-carbs.”

Yes, you've just stumbled down the rabbit hole.

In the real world, pre-surgery, we're told repeatedly a carbohydrate restricted diet is dangerous and no one wants to eat that way anyway; in Wonderland, post-op, a carbohydrate restricted diet is mandatory for success and maintaining health.

So after you pony up $25,000 to have your surgery, face the very real (and often expensive) risk of complications, it's not only safe, but necessary to follow a carbohydrate restricted diet.

Funny, but the media doesn't seem too keen on reporting this either. What they are keen on is selling us the idea that weight loss surgery is the answer to the growing problem of childhood obesity.

I don't buy it, and neither should you.


  1. Anonymous2:15 PM

    makes me want to cry. or at least shout out a warning. But then you've done that very well! Thanks

  2. Anonymous5:12 PM

    I think the whole thing is extremely sad. People are so brainwashed into thinking that surgery is the only answer to all of lifes problems. It should be used as a last resort or to save a life after a trauma but to be used as a weight loss system for kids or adults is beyond evil. I was especially interested in the bit about how a low carb diet is recommended post surgery?? how come it is so good then & not so good before hand?? It just makes me so sad.

  3. It makes you wonder whether the weight loss is from the low carb diet (admittedly an enforced one) or from the surgery. I have a friend who had laparoscopic gastric banding. She did lose a significant amount of weight although like most who have the surgery went from morbidly obese to merely obese. She never lost her taste for sugar however.

  4. I wouldn't put myself through the surgery, to put a child through it is child abuse. doctors who do it should be shot. if they eat junk food now they will eat it later and nothing is gained. I really don't understand where thier head is at! Great post Regina!

  5. Anonymous9:19 AM

    I've always said that WLS was in large part an operation that forces compliance to a low-carb diet. A little like the jaw wiring of old, but much more invasive.

    Now how about this for an idea. Why not put kids on the "two by two" diet before the WLS. Just to see what happens. (We all know what would happen). I wonder what objections they would have to that proposal

  6. I laugh every time I see the ad for lap band surgery where the woman describes her hunger as a roaring lion. I took care of my roaring lion with a low carb lifestyle. No surgery needed.

  7. Back in 1973/74 I assisted at a gastric bypass...they were almost unheard of in those days. I was a freshman in nursing and we had to assist on all surgeries for our patients. I don't remember how long it took, but it was a VERY long surgery. It was a woman that stood over 6' tall and weighed over 500#. She went thru extensive psychological and physical testing and instruction before surgery. She was on liquids only for several months before she could start eating again....and then it was fresh, natural foods only, and in small amounts. She did well, loosing a large amount of weight, but did have several nutritional deficiencies within 2 yrs (last I heard of her), and had to take a special supplement. After discharge she returned monthly for checks with a dietician.

    Since then I have known 3 people who also had some kind of bariatric surgery. Each one lost a large amount of weight, but had to be very careful about what they ate....and 2 of the 3 have gained back almost all the weight they'd lost!! (in less than 5 yrs)

    Today they don't fully inform people prior to surgery, and they don't follow up properly. And now they're doing these procedures on children?

    I saw reference recently about fetal deaths in women that had undergone bariatric surgery prior to their pregnancy (18 months or more). I've done searches, but can't seem to find any info, do you know anything about this? If there is a danger in getting pregnant, then this is also something that needs to be emphasised!