Why I hate WLS

(The following is adapted from an e-mail I sent to the producer of the BBC's 'You & Yours' radio show last year, in response to a call for participants who had undergone or otherwise been affected by bariatric surgery. It resulted in a long discussion with said producer and the presenter of the show, although ultimately my time on air was very limited. I have posted it here as it's quite a good summary of my concerns surrounding the surgery and the 'war on obesity' more generally).

Heather was one of the many unreported victims of weight loss surgery (WLS) who having been persuaded to undergo the full Roux-en-Y gastric bypass in 2005 at the age of just 18, suffered myriad complications including 'dumping syndrome', gall stones, excess skin and associated infections, psychological / neurological disturbances, exhaustion, malnutrition, hypoglycaemia, insomnia, visual disturbances, and other conditions all of which have been associated with this type of gastric bypass surgery. In February 2013 I returned home to find that she had collapsed and passed away; the post-mortem and inquest found that the 'remnant stomach' (the larger part, which is disconnected from the oesophagus and the smaller part of stomach which forms the pouch) had broken down along the suture line and allowed gastric content to enter her chest cavity via a hole in her diaphragm, preventing her from breathing. She had been complaining of intense pain and nausea for several months prior, however had had difficulties getting doctors to take her concerns seriously and was awaiting further investigation at the time of her death. I have since spoken to other bariatric surgery patients who agree that this level of after care and lack of expertise amongst GPs (who are keen to recommend WLS but reluctant to deal with those for whom it goes wrong) is not unusual.

As you will therefore appreciate, the current 'push' (which seems to originate largely from the community of surgeons and other 'obesity experts' who stand to benefit) toward carrying out more such operations, on younger and lighter patients and even as a pre-emptive factor in moderately 'overweight' people to ward of type II diabetes, causes me enormous concern. The claims being used to promote the surgery (i.e. that it can 'cure' diabetes, reduce other 'obesity-related' conditions and thus save the NHS money) always seem to be based on studies carried out on people who have had WLS relatively recently (6 months-3 years maximum). At this stage many people are still in a 'honeymoon period' of losing weight. However the few studies that have been carried out into the long-term effects suggest that as time goes by, the number of complications increase, whilst initial weight loss is reversed. These effects are well-documented, yet never seem to be given anything but the most cursory mention in news reports about the surgery. They are also generally irreversible, which is why I firmly believe that those considering this surgery should be free to make an informed decision free from coercion and pressure (rather than, as Heather did, deeply regret it later).

In short, I don't consider that swapping one set of possible, projected risk factors for another set of serious health problems will save the NHS a penny, in no small part because I also believe that the 'obesity epidemic', based as it is on the flawed BMI, has been vastly exaggerated into a full-blown moral panic. Many of the solutions being proposed (including taxes, legislation, and increased spending on increasingly extreme weight-loss methods including WLS) worry me far more than the constant warnings and calls to arms regarding 'obesity'. I am particularly appalled at the suggestion that more teenagers and children should be persuaded or even forced to undergo it, when their bodies and minds are still developing, potentially condemning them to many years of complications all for a 'quick fix' for bullying or other people's reactions to their weight. However it is also my firm belief that this surgery would remain popular for cosmetic reasons even if it were not presented as beneficial to health. Many people who undergo it do so not to avoid health problems but for relief from the intense, officially-sanctioned stigma of being fat in our society. Prejudice against fat people is not only socially condoned but widely encouraged. Fat jokes have become a mainstay of any comedy routine, discrimination against fat people is rife in everything from adoption and visa criteria to clothing options, air travel and the bullying of fat children and employees. The media overwhelmingly presents the very existence of fat people as a problem with what few positive portrayals and role models there are being condemned by an increasingly shrill anti-obesity lobby as 'condoning unhealthy lifestyles'.

Stereotypes about the dietary / exercise habits, intelligence and morality of fat people have been allowed to flourish and take hold almost completely without challenge, and the idea that society is 'at war' with fat people has become accepted as legitimate without question. Yet the impact of constantly living in such a hostile social climate of blame and scapegoating has (unsurprisingly) been demonstrated to have its own impact on the health of those against which it is directed. I would like to see the number of these operations fall to single figures not increased into the tens of thousands, and I still believe that one day our ancestors will look back in revulsion and horror at the primitive way in which we attempted to force those with bodies deemed 'transgressive' to comply with social norms. Like other weight-loss methods, the argument can be made that WLS only treats the symptoms of a wider problem, and that rather than attempting to eliminate 'the obese', we should be encouraging understanding and tolerance toward people of all sizes. Until this happens, there will always be a market for those looking for what is presented as a 'miracle cure' for a condition which in my view carries far greater social consequences than physical ones.