I’m very pleased to have Sarah McMahon, a Sydney psychologist specialising in eating disorders, write another guest blog, this time on the way the radical treatment of gastric banding is being pitched to teens, with very little attention given to the potential risks.
Promoting gastric banding to 14-year-olds: malnutrition and maintenance on the menu
I am shocked that a research article published on Wednesday by the Journal of the American Medical Association has been picked up, mixed up and hyped up by mainstream media, suggesting that gastric banding is an appropriate solution for “obese” teenagers. The research is typical of what we are seeing coming from the obesity industry, which is looking to capitalise from the condition.
What the research really found
Given the media hype, we need to look at what the research really tells us. Two groups of teenagers were randomly assigned to either a “lifestyle” group, for exercise and a healthy diet, or a “gastric banding” group, for laparoscopic adjustable gastric banding surgery with the main aim weight loss.
The gastric banding group experienced dramatically more weight loss than the lifestyle‘ group. This is not surprising. I would expect that intrusive surgery resulting in necessary food rationing is far more motivating than the “suggestions and encouragement” regarding dietary changes prescribed to the lifestyle group.
And although the extent of compliance between the groups is not clearly reported in the journal article, it requires little imagination. The reflex of a banded stomach is to vomit if the food is not small and well chewed. Not only does this force malnutrition, there is generally limited opportunity for high calorific intake. Of course vomiting is a vastly different compliance measure than the “intermittent food diaries and food counts used to measure compliance in the “lifestyle” group.
The sample size of the study was hardly robust. Less than 50 participants completed the research trial, meaning that statistically no evaluation of single health problems could be generated. This is important when considering the value of the study’s public health significance, given that the scaremongering associated with the “obesity epidemic” has gained so much momentum by medicalising the problem.
It seems that medicalising obesity somehow justifies culturally sanctioned prejudice on the basis that any intervention is “in their own interests”. Interestingly the study determined that despite the vast difference in weight loss in the gastric banding group, both groups experienced significant improvements in general health.
Further, follow up of weight loss measures were conveniently limited to two years, despite overwhelming evidence in research that suggests significant weight regain occurs from three years post surgery.
Industry promoted research
The study was undertaken by Monash University’s Centre for Obesity Research and Education (CORE). Perhaps not surprisingly, CORE receives an unrestricted research support grant from Allergen, which happens to be Australia’s leading provider of gastric banding equipment.
The lead author and pioneer of the lap banding procedure in Australia is Professor Paul O’Brien, who has previously served on the Allergen Advisory Board. Another author of the study reported consultancy with Allergen and membership of advisory boards that include Allergen, Optifast and Bariatric Advantage – all heavy weights in the weight loss industry.
It seems as though the boundary between commercial methods of weight loss, such as weight loss pills and medical interventions, are becoming blurred. Medicalising obesity to justify surgery creates an instant industry, and there is no shortage of businesses lining up to profit from it. Allergen’s webpage proposes alternative payment options, given the surgery is not covered by Medicare. These include the early release of superannuation savings or bank loans via third party medical finance.
The other side of gastric banding
Gastric banding is framed as a quick fix solution to address obesity. But does it address the real problem? Whether it is compulsive eating, binging due to psychological issues, or poor nutritional education, reducing an individual’s stomach size does not reduce the significance of these factors.
For example, eating disorders are not contraindicated, meaning that many people undertaking gastric banding may have severe psychiatric problems that are contributing to their weight gain or pursuit of thinness. I expect that this is one reason why the weight loss from gastric banding ultimately is short term and generally not sustainable.
Further, there is no standardized screening tool for the surgery. I know of countless cases of people engaging in binge behaviour who are offered the opportunity of gastric banding, at huge cost to their health. In our culture of thinness-at-all-costs, it seems that health is a reasonable trade off for thinness. Complicating this further is the fact that the subtext of our culture is that thinness equals health.
The Australian Medical Association’s 2008 report, ‘Bariatric Surgery: A Weighty Issue’, warned against the potential and inherent risks associated with gastric banding.
The cost to health from gastric banding is huge. Studies suggest that patients require follow up procedures to correct secondary health issues such as hernias, gall stones, bleeding, blood clots, infections, gastritis, correcting loose skin etc. In every 1500 cases there is one death (which can’t be corrected).
Common post-surgery complications include:
- Frequent vomiting because the stomach is unable to hold so much food or because food is unable to pass out from the stomach;
- Dumping syndrome which occurs when food enters the digestive tract too quickly, leading to adrenalin that results in nausea, palpitations, sweating and diarrhoea;
- Nutritional deficiency due to malabsorption. This means that people need to follow a lifetime program of consuming nutritional supplements and vitamins;
- Requirement for further surgery due to slippage, repositioning, adjustments and need for replacement of the band. In the aforementioned study, over one quarter of participants required revisional procedures that consisted of removal and replacement of the band or replacement of the access port;
- Permanent eating difficulties including: an inability to digest particular foods, requirement for extensive chewing, difficulty in drinking at meal time, difficulty in eating at certain times during the day, and food becoming lodged in the throat.
These associated health concerns are frightening given that gastric banding is framed as the “next step” when diet, exercise and medication have failed. Descriptions on web pages, brochures and even research reports invariably begin with scaremongering about the “obesity epidemic” followed by cartoon-style drawings of the seemingly simple procedure that will not only make the person thin, but will solve all their problems. Not surprisingly, the “success stories” on brochures and the media focus on the life that was “saved” through gastric banding.
The ability of 14-year-olds to make this decision
Given the associated complications, it is not just me who believes that it is unsafe to be proposing this intervention for teenagers. In November 2009, the Dieticians Association of Australia (DAA) released a ’Position Paper on Bariatric Surgery in Children and Young People‘ which concluded that there is insufficient evidence of the surgery as a safe and long-term solution to weight loss in teenagers. Even Allergen normally requires patients to be over the age of 18 to undertake the surgery.
This begs the question: what teenager has the capacity to make a decision so significant, given the health risks and the lifetime maintenance of such a procedure? How can a teenager adhere to the strict requirements necessary to maintain the band? What happens when they experience other significant life changes, such as pregnancy?
We are talking about prescribing this intervention to people who are in high school who are legally unable to drink alcohol or drive because their brain is insufficiently developed to manage these responsibilities.
Frequent vomiting, permanent eating difficulties and soiling pants may not be the alternative to “obesity”’ that teens really need.
February 12th, 2010 at 11:55 am
Great article. I am so tired of the media grasping and twisting each ‘obesity breakthrough’ – usually to the detriment of people’s health. Subjecting young people to this surgery is not a solution. I also shudder to think how easily such ‘research’ seems to be justified – testing lap band on Indigenous people is another odious practice that concerns me.
February 12th, 2010 at 12:09 pm
I have to agree. I think the issue of how obesity has been medicalised is particularly frightenng given there is overwhelming research emerging that you can indeed be fat and fit. Unfortunately advertising has a lot to answer for this in that the easiest method of creating desire is by making people feel inadequate. The sickening thing is that this has extended way past the latest shoes and computer games- to the body. I think that framing obesity as a medical issue is just a socially acceptable way of making what is essentially cosmetic surgery somehow justified- because it is “medically necessary”. I think this is the crazy thing about the research that Sarah has discussed- because it seems there were improvements in general health in both of the groups, not just the group that lost all the weight. To me this highlights that the problem is not obesity itself- other factors could have impacted on the improvements in general health, such as dietry changes, support or increased excercise.
February 12th, 2010 at 2:00 pm
Thankyou so much for this post.
I was diagnosed with type two diabetes 18 months ago, just after the hype about gastric banding being a “cure” for type two diabetes came out. The number of people who told me I should get gastric banding was staggering, doctors, people on the street, rellies, friends, everyone was recommending it. My reply – of course eating less is going to lower my blood sugars, thats a no brainer, but that’s a bandaid solution, not a cure! Also, the con’s WAAAY outweighed the pro’s for me, and your post has reassured me that my decision not to have the surgery was the correct one!!!
I find it amazing that a medical procedure is allowed to be advertised in any way. Surely recomending a surgical procedure should be the responsibility of a specialist only, why is this procedure advertised in diabetes magazines, and other media, as an easy and suitable weight loss strategy? It’s like advertising a hysterectomy as birth control!
February 12th, 2010 at 2:11 pm
Thank you for taking the time to dissect this proposed ‘solution’ Sarah.
February 13th, 2010 at 5:54 pm
Thank you Sarah for raising this issue of the ‘medicalising’ of ‘obesity.’ As a psychologist specialising in the prevention of eating disorders, I believe that the Australian public need to hear this particular truth:
95% of research into obesity is funded by private industry including pharmaceutical companies.
This is a massive conflict of interest!
The research report Sarah has dissected regarding gastric banding promotion for teens, is typical of how research is frequently reported by anti-fat warriors. That is, they (1) frequently cite research that either does not even support the claims they make, or (2) promote ‘bad’ research that supports their established view and ignore ‘good’ research that contradicts it.
The fact is that the majority of research into obesity does not account for numerous confounding factors, such as: binge-eating, previous history of dieting, weight cycling (which is far more damaging to one’s health than staying at a higher but steady weight), sedentary lifestyle, etc
For example, we know that binge-eating itself significantly inflates a person’s risk of developing type 2 diabetes, INDEPENDENT of weight change. Why is this frequently unaccounted for in the research?
The majority of Australians who match the criteria for ‘obesity’ exist with a BMI of between 30-35. That is, they are not ‘morbidly obese’ to the point of being immobile, but unfortunately when one says ‘obese’ often only the extreme cases are visualised. Rarely do we consider that your average rugby league player would fit this description, or that people can actually be fat and fit.
Pushing weight loss as the ONLY solution to assumed health problems (that’s right- if you have a BMI of 31 but no health problems, you are considered ‘obese’ and therefore your body is a ‘ticking time bomb’ ) – is harmful to our health.
I am afraid that gastric banding is going to be the next form of plastic surgery to become fashionable – the company Allergan, as Sarah has blogged about, not only makes gastric banding products but also breast implants and other products that are part of the plastic surgery industry. Numerous health complications are likely – don’t be fooled that this is an issue about health- this is about the beauty industry co-opting a language of health, and corporations capitalising on promoting fear about ‘fat’ bodies while watching their bank accounts inflate.
We should be promoting the adoption of a healthy lifestyle, independent of weight.
February 13th, 2010 at 6:07 pm
To date, all non-surgical weight loss approaches carry a 98% failure rate. Increasing shame and pressure to lose weight is significantly more likely to lead to harmful weight loss behaviours, depression, and decreased participation in exercise due to body shame (eg high school girls refusing to participate in PDHPE because they loathe what they look like in their sports uniforms)
While some reports suggest that weight loss is more successfully maintained with gastric banding, the fact is that the health improvements initially gained from this, often drop off after 6-18 months – even when weight loss is maintained. Not to mention the numerous (and often permanent) medical complications that one is likely to be left with !
In my clinical experience I have seen patients who have had lap banding performed on them, despite having identified severe binge-eating disorder. Predictably significant weight gain has occurred, leading to the lap band needing to be loosened, however medical complications remain. For example one of my patients now vomits regularly, twice a week. This is not always due to overeating, and ironically, she is far more likely to vomit when she has eaten healthy food rather than highly processed, easily digestable foods. She also finds certain foods get ‘stuck’ in her gut (such as lettuce) at unpredictable times, leading to immense discomfort. These are just some of the consequences of this surgery. Is *this* what we mean by ‘health’?
Not to mention the $5000 it will cost to have the lap band removed.
February 16th, 2010 at 12:19 am
It’s great to hear alternative views on lap band surgery. In most major newspapers and magazines, lap banding is presented as a safe, ‘miracle’ surgery, which promises to cure all ills. I’m overweight (I have an unfortunate habit of eating when i study and am nearing the end of a PhD. Go figure) and did some research on lap band surgery, and decided that it was a lot more risky than the mainstream media suggests.
It’s interesting too how obsessed our current society is with weight alone. I was told by my GP that even though I’m overweight, because I play hockey a couple of times a week, take the dog for daily walks, and walk to work, I’m probably a lot healthier than many of my skinny friends who smoke and for whom exercise is a dirty word.
February 16th, 2010 at 12:28 am
Media Watch has a succinct summary of the media coverage of the research findings: http://www.abc.net.au/mediawatch/transcripts/s2820435.htm
June 25th, 2010 at 8:11 pm
how to eat healthy everyday…
glycemic impact diet meal plan…
July 23rd, 2010 at 10:57 am
[…] article was written by Sarah McMahon and was first published on Melinda Tankard Reist’s blog on 12 Feb […]