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.

French ban on skinny models - implications for size activism?

http://www.bbc.co.uk/news/world-europe-32174364
It might come as a surprise to some who know me, but I actually find this development profoundly worrying. Don't get me wrong, I understand the reasoning behind it. Anorexia is a horrible illness that (whatever we may be told) kills far more people and far younger than so-called obesity. I know that the enforcement of the oppressive weight standards that prevail in the world of high fashion modelling, and the actions of fat activists and plus-sized models attempting to reclaim their own identities and allow others who have been told that they are flawed, unattractive and of lesser worth are two entirely different things. Now, I know that the enforcement of the oppressive weight standards that prevail in the world of high fashion modelling, and the actions of fat activists and plus-sized models attempting to reclaim their own identities and allow others who have been told that they are flawed, unattractive and of lesser worth are two entirely different things. And yet, the thrust of many of the comments threads on this story overwhelmingly indicates that I am in the minority in holding this view. Most of those commenting on the Guardian and Daily Mail versions of this item have relatively little to say on underweight models, but wax apoplectic about the fact that it is still OK to say that 'big is beautiful' or for their child to be taught about obesity by a fat teacher or treated by a fat nurse, doctor or social worker (all professions that have been charged with the task of denormalising fat).

It would be easier to dismiss them as the usual fat-hating rantings of the online commentariat were it not for the fact that doctors and activists have at various points in recent years made the same demands. Such is the power of the argument that even the mere sight of a fat person (unless being chastised by Jillian Michales or sobbing into their pizza on a Ch4 documentary) amounts to 'promoting an unhealthy state', that one MP even went so far as to advocate all NHS and teaching staff being given 12mths 'grace' to get their BMI under 25 by whatever means necessary, or face suspension / termination. The fact is that despite howls of outrage about 'normalising obesity', media weight standards are such that the numbers of fat singers, kids' TV presenters etc are so small as to be inconsequential. Consider the enormous controversy and hate generated by Tess Holliday, the first ACTUAL fat model to make inroads into mainstream culture. But that's not really why Tam Fry, Jamie Oliver et al want weight limits for those considered 'role models'. For them, and I suspect for many of those supporting this course of action, it's another symbolic opportunity for those who through their 'correct' weight have access to the moral high ground to reinforce the lesser status of fat people, and present their very presence as being harmful to the social good.

In the UK, there have been calls for a ban on underweight models for many years. (Before the 'obesity' hysteria, the Govt and many councils supported a more varied representation of different sizes, including larger people, in media). Currently, websites and pages deemed to be 'promoting' an unhealthy body size (and just imagine how that language could be turned against size acceptance with very little effort) are automatically blocked by ISPs and may soon be censored altogether under David Cameron's firewall scheme. Obviously I don't like or approve of pro-anorexia websites (not least because they are, as you'd imagine, often viciously fat-hating) but on this occasion I am far more concerned about the idea of using the law to mandate a particular acceptable size and potentially, to suppress the ability to even speak freely about weight and size. For the first time it is not inconceivable that by running a blog or making a FB post stating that it's OK to be fat, that fat people are beautiful, valid and deserving of rights, etc, I and many others could end up on the wrong side of what would be a profoundly bigoted and unjust law. How that would help the sufferers of anorexia and bulimia (and I know of several whose exposure to fat acceptance helped them overcome their condition) is really anyone's guess...

Why it's always worth doing your research...

http://www.newstatesman.com/…/thin-people-don-t-just-eat-di…

Oh Helen Lewis, I am so over you. For so long I thought you were a quirky, slightly geeky, rare feminist on the BBC; turns out from a quick Google that you're just yet another lazy clone soldier in the War on Fat People (TM). No, American reality TV isn't a true reflection of the real lives of actual fat people. And arguing that fat people are victims of an obesogenic environment run by Big Junk Food is every bit as patronising and harmful as claiming that they need only grow some willpower and put down the fork. How can someone be so switched on with regard to a wide range of other social justice issues and yet believe everything they're fed on this? Typical lefty blind spot when it comes to seeing fat as a matter of identity, discrimination, human rights and not just a 'health crisis' to be vanquished at any cost.

Diet pills are back - the hunt for new obesity drugs

One of the advantages of the BBC's new smart phone app is that I can set it up to provide instant notification of any news stories about 'obesity', which is now one of the specified topics under the Health section. (I first wrote to them asking for this in 2007, by the way - the Guardian has for many years listed all the fat stories under a keyword, allowing fast location of those of interest). It's immensely useful for someone interested in staying up to date on news stories around this topic, even if the quality and tone of the articles themselves often leaves a great deal to be desired.

http://www.bbc.co.uk/news/health-31794430

According to today's notification, they're once again playing around with diet pills - medication that induces weight loss through malabsorption, appetite suppression or metabolic changes without the restrictive eating associated with conventional dieting or the dangers of surgery. When anything is regarded as the 'holy grail of modern medicine', there is inevitably immense pressure on researchers and drug companies to rush it to market before all the bugs are ironed out. And in the case of Phen-fen, one of those 'bugs' was that it destroyed users' heart valves and resulted in elevated rates of often fatal pulmonary hypertension. Only after numerous deaths and a multi-million dollar lawsuit did the makers recognise that there was a problem and pull the drug.

Then there was rimonabant, which was never approved by the FDA and withdrawn in the EU in 2009 after it became clear that it was causing major depression and even suicidal ideation in many users. A year later, sibutramine (widely seen as the great hope against obesity) was pulled from sale after reports of sudden death, heart failure and renal failure. Currently the most popular 'diet pill' is Orlistat, marketed as Redux or Alli, but this is expensive, its efficacy limited, and its side-effects embarrassing (including fecal incontinence and excessive flatulence) and potentially dangerous (early studies have linked its use with liver damage, early signs of colon cancer and inability to absorb fat-soluble vitamins).

Even so-called 'natural' supplements aren't without their risks - Ephedra, a traditional Chinese preparation from the plant of the same name, has in recent years become popular as a weight-loss supplement but was banned in the US following mounting evidence of side effects ranging from the mild (rashes, itchiness, nervousness, irritability) to the deadly (heart attacks, strokes and seizures resulting in sudden death). Currently the most popular 'herbal' fat treatment is bladderwrack, a seaweed extract widely available in pound shops and suchlike in the UK, but despite being regarded as safe, again its effectiveness has been largely dismissed.

In other words, there is no safe, effective drug-based weight loss treatment, and there is unlikely to be, because the processes which influence weight gain and loss are either complex and linked to the body's basic biological mechanisms such as appetite, metabolism, absorption of nutrients, which are difficult to manipulate without countless unwanted side effects, or like genetics, outside the realms of that which can be influenced by drug treatments. Of course, none of this will stop them trying, as it has frequently been said that the man who invents a way to make fat people safely and permanently thin (and it would most likely be a man) would become an overnight billionaire. And there we have it - one of the main motivators behind the 'war on fat people'.

IDS: 'Obese' benefit claimants should be forced onto liquid diet

Well isn't this interesting.

http://www.politics.co.uk/…/liquid-diets-iain-duncan-smith-…

It seems that Minster for Workhouses (not his title, but maybe it really should be) Iain Duncan-Smith, yes he of the £39 breakfast expenses claim fame, has previous form in the fatty-bashing stakes. Late last year he not only suggested forcing 'obese' recipients of unemployment and disability benefits to undergo the ultra low-calorie Cambridge Weight Plan, but held several meetings with the director (Sir Anthony Leeds, who incidentally also frequently pops up in the media as an 'obesity expert') of the company AND applied pressure to the health secretary to consider setting up an interdepartmental group to consider the efficacy of ultra low-calorie liquid diets as a means of getting benefit claimants back to work. Never mind that these programmes (like all diets) have little proof of their long-term effectiveness, their safety has also been called into question. But if you're IDS, those concerns are irrelevant next to a strategy of making benefits conditional and kicking out, again and again, at those least able to defend themselves.

(Trigger warning: the linked article is very fatphobic, contains a Weight Loss Journey (TM) story, lots of scaremongering about the 'projected implications' of 'obesity', statistics taken at face value, conflation of weight and health, etc etc. However I wasn't able to find a version that DIDN'T incorporate these elements - itself revealing, of how the media can't even report a story about the infringement of the rights of fat people without the obligatory reminder that 'fat people are a very bad thing').

Child mental health and the 'war on obesity' - two sides of the same coin.

It never fails to make me laugh when I hear doctors and experts banging on about how we need to 'do more' to eliminate so-called childhood obesity. Especially when in the next sentence they go on to bemoan the growing mental health crisis amongst Britain's children and youngsters, who by many measures are some of the most depressed, angry, stressed and anxious in the world.

Here's a perfect example: http://www.bbc.co.uk/news/health-31661794


Don't they realise that the obsessive focus on beating our kids around the head with the message that fat is the worst thing ever is one of the major sources of those mental health problems? And that's not only in fat children who now spend their entire childhoods being poked, prodded, weighed, pathologised, problematised and reminded a dozen times a day that their 'unacceptable' bodies reflect poorly not only on them but on their parents too.

It also affects the average-sized and thin children who are encouraged to fear fatness and the accompanying stigma - the kids who end up throwing away their lunch, who bully fat kids as a way of reinforcing their 'normal' status, whose parents become preoccupied with calories, exercise, and other things that under-10s shouldn't even have to worry about.

Look. Cookery lessons are good. It's a useful skill to have, though no panacea in a world where work demands ever more of our lives. Running about outside (provided it doesn't become a power trip for the PE teacher, and allows those who don't enjoy competitive team sports to find other ways to move) is good, as kids have far more energy than adults, and a lack of an outlet can cause behavioural problems. Providing a hot nutritious meal at lunchtime, originally motivated by the numbers of children going hungry, is good (and yet, that original goal has been undermined by reductions in portion sizes motivated by fear of 'obesity').

But for me it's all about the way it's framed. And these days, any such initiative has to be motivated by a desire to 'fight obesity'. 'We're not putting in bike lanes to provide a safer and more sustainable way of getting about. We're doing it to make the fatties thin'. What a negative motivation, and one that reminds fat and thin alike that this is about solving the 'problem' of their existence. I would much rather see the approach favoured in the 2012 'Reflections' report, which because its conclusions didn't support the obesity moral panic was ridiculed, denigrated and ultimately forgotten.

I am actually surprised that 'childhood obesity' HASN'T been a bigger election issue. But I suspect that's largely down to the cozy consensus amongst every one of the parties. None have indicated that there will be a ceasefire or even a tactical withdrawal in the war on fat people. They all take the legitimacy of its existence as a given. More worryingly, if the figures reported in the article are correct, the majority of the public have fallen for it. The Royal College of Paediatrics has very much got its own way, and it doesn't even seem to realise it.