December 27, 2016

"... a Reese’s peanut butter cup gave her such a rush that it was... 'like an orgasm of pleasure in my brain.' Now... 'It’s just peanut butter and chocolate. What’s the big deal?'"

A bariatric surgeon tells us about one of his patients, in a NYT article (by Gina Kolata) that takes the position that the weight loss after the surgery is not due simply to the reduction in the size of the stomach. We're told that "scientists have discovered that it actually causes profound changes in patients’ physiology, altering the activity of thousands of genes in the human body as well as the complex hormonal signaling from the gut to the brain."

I can't help feeling skeptical. "Scientists" — what scientists? There's a huge financial interest in performing all this surgery, and there's a lot of pressure to reduce medical spending. Doesn't that skew the research?

It's a long article, but the actual science part is minimized. Here's the most technical part addressing my skepticism:
It has become clear that bariatric surgery changes the entire setting of a complex, interlocking system. There is no one place to tweak it. To show what is involved, [Dr. Lee Kaplan, an obesity researcher at Massachusetts General Hospital] reports that surgery immediately alters the activity of more than 5,000 of the 22,000 genes in the human body.

“You have to think of it as a whole network of activity,” Dr. Kaplan said. It’s a network that responds to the environment as well as to genes, he added. Today’s environment probably pushed that network into a state that increased the set point for many people: Their brains insist on a certain amount of body fat and resist diets meant to bring them to a lower weight and keep them there.

“Surgery moves the network back,” Dr. Kaplan said.

But surgery only alters the intestinal tract. That tells you, Dr. Kaplan says, that there are whole classes of signals coming from the gut and going to the brain and that they interact to control hunger, satiety, how quickly calories are burned and how much fat is on the body.

One major hormonal change is in bile acids. There are more than 100 varieties of these hormones, which help regulate metabolism and digest foods. They send out broad signals, like television signals, to any cells in the body with the capability to respond. And the relative proportions of the different bile acids change immediately with surgery.

Neurons, which signal specific targets in the brain, change, too. And so do white blood cells of the immune system that send their own signals. Although they are usually thought of as fighting disease, white blood cells play a major role in setting a person’s weight by, among other things, helping control metabolism.

The gut’s microbiome — the thousands of strains of bacteria in the intestinal tract — changes, too, immediately and permanently. Its interaction with the rest of the network is part of the weight-loss picture.

But for bariatric surgery to work, the setting in the brain that determines how much fat a person will have — what Dr. Kaplan refers to as the body’s thermostat for fat — must have been set too high, not broken.

A few rare genetic mutations break the thermostat. People with those mutations have no internal controls on their fat and grow enormously obese. Bariatric surgery has no effect on them. People like Jessica and Keith, whose thermostats were mis-set, reach a point at which they are obese but their weight holds steady without any effort on their part. Surgery can lower their thermostat’s setting.
I invite you to critique that as science. To my eye, there's a theory — the gut must affect the brain — and a metaphor — the thermostat — superimposed on the anecdotal experience of the surgery working for 2 patients.

And someone decided to title the story: "After Weight-Loss Surgery, a Year of Joys and Disappointments/Even as the pounds fell away and their health improved, two patients contended with the feeling that life hadn’t changed as much as they’d hoped."

That utterly eclipses the scientific question of why the surgery works — whether it's mostly or only because the patient can no longer fit much food into the stomach.

The article does focus on the psychological state of the 2 patients, and the stress — in the headline and the text of the article — is on the lack of change in their psychology, in their brains: They felt "that life hadn’t changed as much as they’d hoped." So where does that leave the scientific explanation which is about how profoundly the brain has changed physiologically?

Something's missing, I think.

I'd like to see a lot more detail on the cost of the surgery in relation to the success, the economics of the research, and the politics of fighting for acceptance of expensive treatments for conditions that many people perceive as belonging within the realm of individual responsibility.

Speaking of article titles, I've wandered far from my own post title, so let me end by saying "orgasm" — the word that jumped out at me — is a metaphor in that quote about Reese's peanut butter cups. The doctor used it to grab us. Grab us by the pussy, one might say. Grab is another metaphor. We love the concreteness of these metaphors. Metaphors grab us. Not really. Just metaphorically.

Metaphor is poetry, not science. When surgeons come at me with metaphor, it triggers my bullshit detector. That's this thing in my brain. Next to the thermostat.

Don't bullshit me, surgeon. You need to cut right to the core.

72 comments:

David Begley said...

The NYT is now the leading publisher of fake news. One simple trick that Libs love to use is to invoke "science" and then not critically examine the actual data. It worked great with the CAGW billion dollar scam.

exhelodrvr1 said...

Disastrous climate change caused by humans. It's science.

Arthur James said...

https://www.youtube.com/watch?v=xCVgsI5h9p0&index=5&list=RD9iGxoJnygW8 sorry lost to my own world

Owen said...

That string of assertions sure looks science-y with its talk of 5,000 genes changing their pattern of expression after this surgery. But when you pause and ask "How do they know this? Which studies, of what design, run by whom, on what population, with what statistical power, with what results?" And after you take a breath, you ask "Who paid for those studies (because they ain't cheap; and doing gene expression analysis on the scale suggested here --establishing definitely that this surgical intervention will always and everywhere re-set in patients a quarter of their entire genome *permanently*-- would cost an absolute ton)?" And when you take another breath, you ask "Where can I read these findings; other than in this infomercial by a once-respected journalist?"

Not impressed.

Ann Althouse said...

"Disastrous climate change caused by humans. It's science."

Speaking of metaphors: Greenhouse.

sparrow said...

Any bariatric patient might reasonably be expected to be abnormal with respect to food sensation already. So I'm skeptical too.

Teasing out what part of the effect is due to weight loss and what is from surgery is not that straight foward. If the stomach reduction surgery patients are compared to those who are stapled or banded that might tell us something.

Ann Althouse said...

"That string of assertions sure looks science-y with its talk of 5,000 genes changing their pattern of expression after this surgery. But when you pause and ask "How do they know this? Which studies, of what design, run by whom, on what population, with what statistical power, with what results?" "

The answer to "how" is this metaphor: "They send out broad signals, like television signals..."

Television!!

Bill Harshaw said...

The book "Gut" is very interesting. Not specifically on the surgery, but on the gut generally, and bacteriologically.

David Begley said...

I doubt Linda Greenhouse still reads the Althouse blog after that last exchange. She was exposed as a liberal shill; if that wasn't already clear.

It wouldn't surprise me one bit if the failing NYT is now taking side money to publish fake news. Renting out eight floors of its building says plenty.

Above comments are spot on regarding cost of the study. Easy six figures.

rehajm said...

...like an orgasm of pleasure in my brain...

I'll have what she's having

FleetUSA said...

Headlines are rarely clear explanations of the content. Their purpose is to grab us. Lo-fo voters only read them, if that

FleetUSA said...

By the way at the bottom of thr Althouse post I see a link for "Pediatric Plastic Surgery " insidious internet.

Laslo Spatula said...

The premise of the film "Deep Throat" was that Linda Lovelace's clitoris was located in her throat,

So eating chocolate might indeed have given her an orgasm if the woman in the article is so afflicted.

I wonder if the doctors checked for that.

Although I would then suspect that it would be easier for her to reach orgasm with a "Big Hunk" rather than the peanut butter cups.

Or at least a King-Size Snickers.

I am Laslo.

JAORE said...

More theory, sciency, click bait.

Like cancer cures right around the corner, diabetes cured with this one simple food, global warming (could not resist), flying cars, and free energy through nuclear fusion.

Always one step away... early results... or some Doc speculating....

The MSM covering science is like Doctor Oz in print.

She shakes, she shimmies, she crawls on her belly like a reptile. Hey Rubes!

sparrow said...

"How do they know this? Which studies, of what design, run by whom, on what population, with what statistical power, with what results?"

I do this kind of analysis for a living. It's likely RNA seq: the massive simultaneous sequencing of the gene messenger transcripts. For each biological sample ~20 million short sequences (reads of about 100 bp) are mapped to the human genome and counted. Then the replicate sample counts are compiled in a matrix, normalized and tested statistically (usually with a Bayesian moderated t test in R ) for categorical differences. Next a false discovery rate is applied to adjust the ~25K pvalues for multiple testing. It's very well established in the research community.

That said 5K is a lot of transcriptional changes. I bet the 5K number does not include a false discovery rate adjustment or the signal is swamped by infammatory and wound response genes expected after surgery. Even if the result is fully authentic, intrepretation of expression changes is not trivial and depends heavily on the experimental design and the choice of controls.

So you are asking all the right questions.

David Begley said...

I am NOT asserting any wrongful conduct or skulduggery, but consider the following.

Cologuard a/k/a Exact Sciences (EXAS) is based in Madison. A wonderful company. It has patented a non-invasive test to detect colon cancer. Somewhat controversial as opposed to a colonoscopy. But consider the value to EXAS of studies proving its test is just as predictive as a colonoscopy. The results of studies drives approval by health insurance companies to pay for the test. EXAS has gone over the top and direct to the consumer with TV commercials.

(I think a positive EXAS test does lead to a scope to remove cancer or polyps but the first easy test avoids the expensive and invasive procedure.)

Cui bono?

Owen said...

Sorry to beat on the very dead horse but I am stuck on the stupidity of this 5K gene claim. Consider: we don't know what all our genes are doing (we don't even know what is a gene, that is an active chunk of DNA; the "junk DNA" keeps surprising us). Even if we knew perfectly what the genes were £and* what they each did, and what they did *with and to each other in combined operation* we would still not be ready to run a study of the kind implied by this article. If we sample blood chemistry before/after the intervention and we see (say) 50 parameters move up and 50 move down and 50 stay the same --in every subject-- what does that tell us about the 5K genes putatively responsible? (BTW I don't think there is such a test, certainly not an established one in regular scientific use; and if there is, it must cost $$$).

The point is, until you have elucidated the causal network in that tangle of genes (which we haven't) and mapped how that activity corresponds to the physiological signals or biomarkers you can observe in the patient (which we can't), you are just playing with words and throwing out some guesses.

Note also the role of the brain in signaling or registering satiety. If you thought the microbiome was hard to read, try deciphering neurochemical states in that mysterious bone-guarded mass. You will have trouble getting past its wall of anecdotes about how much it used to like a candy bar.

Fascinating problem, though.

MikeR said...

Good call, Professor (do we still call you that? Did we ever call you that?) As with all science articles, the right answer is: Wait. Some things work out, others don't and are forgotten.

mockturtle said...

We all know that scientists are a monolithic group.

Owen said...

Sparrow: great comment and I defer to you and others who really know this stuff. I can only voice a basic skepticism about how much can be learned and how much less can be said with any confidence. And then, how *very* much less can be said without drawing the fire of regulators. Maybe bariatric surgery is outside FDA remit but what do professional bodies have to say about these assertions?

Ann Althouse said...

Thanks, sparrow.

I would like to see a lot more honesty in the science press about exactly how they are coming up with these assertions about genes.

Otherwise it's like they're just trying to wow us with numbers: 5,000!!!

Eleanor said...

While I'm well aware anecdote does not equal data, I have five people in my circle of acquaintances who have had this surgery. One has lost a great deal of weight and kept it off for seven years. One weighs about the same as she did pre-surgery. Two weigh more. And one is dead. None of them reported having orgasms while eating.

Ann Althouse said...

"Good call, Professor (do we still call you that? Did we ever call you that?)"

Unless they vote against me, I will be a Professor Emerita and still properly addressed as "Professor."

sparrow said...

Owen look up RNA seq and the leading company Illumina in San Diego. We actually know an substantial amount about many genes and intergenic regiongs ( what used to be called junk), but our understanding is definately uneven and incomplete. We routinely measure about 30K genes in a human sample each time and it's about $500/ sample. Although the machines that do the sequencing are very expensive.

This is not at all cuuting edge BTW : it's now possible to sequence RNA from single cells.

sparrow said...

My spelling is a mess , sorry writing to quickly

Ann Althouse said...

If bariatric surgery is a great idea because it destroys the pleasure of eating — you go from "orgasm" to it's just fuel — then why shouldn't we castrate sex offenders?

sparrow said...

should be too quickly, case in point

David Begley said...

Posted without comment regarding Latin.


"Emerere is a compound of the prefix e- (a variant of ex-) meaning "out of" or "from" and merēre meaning "earn". The past participle of emerere is emeritus, and the original meaning is "to serve out, to complete one's service".The female equivalent, emerita (/ᵻˈmɛrᵻtə/), is also sometimes used, but as is often true of loanwords, the use of the donor language's inflectional system faces limits in the recipient language. Although Latin and some Romance languages inflect professor/professora for men and women, in English professor is not inflected for gender (both men and women use it), and Emeritus is often similarly uninflected."

From Wikipedia.

tcrosse said...

then why shouldn't we castrate sex offenders?
Which pre-supposes male sex offenders.

traditionalguy said...

Query: Does this support the claims of Osteopaths to transform disease to health in a human body with drops of herbs dissolved in water?

Paco Wové said...

I bet the 5K number does not include a false discovery rate adjustment or the signal is swamped by infammatory and wound response genes expected after surgery."

My first thought too. What sort of responses would we see after other sorts of major abdominal surgery?

"Oooh, look at all these CHANGES we were able to induce by ripping up this guy's intestines" isn't, by itself, very interesting.

Bob Boyd said...

Global warming is likely to disproportionately impact fat people, making them even fatter, because cookies are going to seem like they're fresh out of the oven all the time.

Paco Wové said...

"Neurons, which signal specific targets in the brain, change, too."

This sentence bothered me also. The previous sentence is about a change in the secretion of bile acids; now we jump without transition to asserting that neurons, cells, "change". Which ones? How?

The construction of the sentence is just weird, almost as though the reporter didn't know that neurons are brain cells, not chemical compounds. Back in my A&P teacher days, I would have given a student a talking-to if they had put something like that in a test answer.

Sydney said...

If bariatric surgery is a great idea because it destroys the pleasure of eating — you go from "orgasm" to it's just fuel...

It doesn't. There's a high failure rate because the people who get joy out of eating (or who have other pyschological reasons for overeating) continue to eat more than they should and defeat the surgery in the long run. Considering that they have been surgically altered to be in a state of malabsorption, that's quite a feat. The most maddening thing about this bariatric surgery bandwagon is that all of their data stops at 5 years, even though there are people who have had the surgery 10, 15, even 20 years ago still walking around. It is one of the things that has caused me to grow disillusioned with my profession.

mockturtle said...

If bariatric surgery is a great idea because it destroys the pleasure of eating — you go from "orgasm" to it's just fuel — then why shouldn't we castrate sex offenders?

Good question, Ann, though I recognize it was hypothetical. OTOH, we probably should.

MadisonMan said...

@BillH, thanks, I'm always looking for good books to read.

Karen of Texas said...

"...altering the activity of thousands of genes in the human body as well as the complex hormonal signaling from the gut to the brain."

Should one be so 'casual' about such a thing? Ooo. Look. We can futz up all kinds of gene activity and hormone signaling. I suspect that some of that futzing might be detrimental.

On a side note, Obama signed the "Countering Disinformation And Propaganda Act" into law and vitual reality - think Oculus Rift - is set to be another minefield rife for gathering (and interpreting) very intimately detailed digital surveillance about you, the user. The near thing is, it can also be used to 'program' you - kind of like what they could also possibly do by futzing with your genes I bet.

sparrow said...

It's always a good idea to be skeptical of scientific reports in newspapers: they are frequently over-simplified and can in some cases invert the meaning of a statement. Further they almost always exaggerate the significance of finding for effect. I've only been quoted once in the press and once on radio but both times I was pushed for more dramatic statements. Sometimes showboat scientists are seeking the limelight before the science is truly settled.

Real scientists publish in scientific peer reviewed journals , which generally are too technical (lots of jargon) for anyone outside of the particular field of science to follow.

There are more accessible articles in these outlets worth looking into.

Here's a fun one from Nature on an unexpected development in material science:

http://www.nature.com/news/graphene-spiked-silly-putty-picks-up-human-pulse-1.21133

FleetUSA said...

Professor sounds better than "Professor Emerita". PE sounds as though senility is near. Your sharp mind is appreciated by all of us.

Wilbur said...

"Or at least a King-Size Snickers."

Open wide for Chunky!

EDH said...

"It's all in your head."

Owen said...

Sparrow: thanks for reference to RNA sequencing and I will try to bone up. It is incredible stuff and has come a long way, with much more to come. What I remember from touring Celera and watching those floors full of automated sequencers and the servers filling with their digital deconstruction, was the brute-force elegance. Craig Venter wasn't going to let 2 billion base pairs stop him. We would establish a base camp (consensus sequence) and then figure out what it might mean. Which we are doing. And given the combinatorial impossibility of establishing all the interactions one by one, we have to do it with mash-ups and probabilities with lots of expressed (and suppressed) fingerprints. Which for me just points to the need for lots of context, lots of controls, lots of comparators. The fact that one commenter above talks of knowing 5 people who have undergone this procedure with wildly different outcomes, suggests that it is not well understood or applied. Not surprising: if you set a broken bone, the body heals the break with little need for changed habits or appetites. But food? It is both fuel and pleasure. The mind is very much involved. I hate to think how much of the surgery may be part of a psychodrama beibgvplayed out in the patient. First the self-mutilation of obesity, then the self-mutilation of cutting out one's own guts.

sparrow said...

Owen: I agree the biology is too complex to understand with one experiment and the article to simplified to read too far into.

My wife helped set up Celera, she worked for Applied Bio at the time. My current boss worked for Venter and she helped write those early mappers. Although they didn't meet then: those were heady days of "Big Science". Those eaarly pioneeers, like Venter or Lander, provided the basic infrastructure all of our new discoveries are leveraged off of them. Those capilliary sequencers based on Sanger sequencing are just used for polishing long reads and validation now. Today Hudson Alpha can sequence a whole human genome for about $1K in just week or two.

Ron Winkleheimer said...

Somewhat related, I saw an article today stating that the recommended daily calorie intake (2500 men, 2000 women) was set just after WW I and is probably too high for people today because they live much more sedentary lives than in the past.

Ron Winkleheimer said...

Today Hudson Alpha can sequence a whole human genome for about $1K in just week or two.

Just curious, how can those companies that you send some spit to tell you what your ancestry is for $99 if it costs

Ron Winkleheimer said...

sorry

$1K to sequence a human genome? I take it they aren't sequencing the whole genome?

sparrow said...


Just curious, how can those companies that you send some spit to tell you what your ancestry is for $99 if it costs > DNA is extracted from the the salivia and hybridized to an array of sequences with know variation about 600K of them. Some of these are linked to ancestry.


$1K to sequence a human genome? I take it they aren't sequencing the whole genome?

They are sequencing nearly all of it, excluding hard to map repetitive regions Although coverage depth varies quite a bit. No a days if you are a cancer patient at a top research hospital they sequence you and your tumor.

sparrow said...

I really need to proofread "now a days" odd phrase really

Michael K said...

"why shouldn't we castrate sex offenders?"

First, that probably does work for many of them and many male sex offenders request it be done so they can stop the dreams and fantasies. The state of California refuses to do it for "cruel and unusual" reasons.

Second, my bullshit detector went to the red zone. I don't read any NYT links because I refuse to subscribe. I used to do that surgery.

The gastric staplings almost always failed. The bypasses have a lower failure rate. What had real long term success was the old jejunal ileal bypass but it had about a 25% complication rate and some was fatal. Those that did not have the complication loved the result and I had a couple of patients that I operated on for other reasons who told me to PLEASE not disturb their old bypass.

What is interesting is the gut microbiome research, which may have the real answer. There has been some preliminary research that a fecal transplant (contrary to the ravings of one of your idiot commenters) may end severe obesity. Transferring the gut microbiome for a thin person to a fat person my end the obesity. Maybe the old bypass did alter it.

sparrow said...

The gut biome work is fascinating. Instead a of sequencing one organism you sequence whatever DNA you find and infer through known variation which microbes your looking at. Diabetics have a distinct profile, as you might expect so the link to metabolism is there. Lots of to p notch had journal articles on this technique a few years ago. Clinical translation takes time however.

Ron Winkleheimer said...

I saw an documentary on people getting stomach reduction surgery years ago.

As I recall they got counseling before the surgery and it was stressed that since they were going to have such a small stomach they would need to eat nutritious food so as to not risk being malnourished. So, of course, after the surgery a couple of the patients, once home, are filmed eating cookies from a box.

HoodlumDoodlum said...

Ann Althouse said...The article does focus on the psychological state of the 2 patients, and the stress — in the headline and the text of the article — is on the lack of change in their psychology, in their brains

I'm very tempted to say something about "the mind" <> "the brain" but maybe that's a rabbit hole we should avoid. Still, you and/or the article seem to be conflating psychological happiness with physical health--they're certainly linked but they're not the same thing! The weight-loss surgery could be successful in terms of getting someone's weight down but unsuccessful in terms of that person's happiness; it's proper to ask "in that case, is the surgery worth it/a good idea?" but that'd probably require a separate answer from each individual.

Ann Althouse said...If bariatric surgery is a great idea because it destroys the pleasure of eating — you go from "orgasm" to it's just fuel — then why shouldn't we castrate sex offenders?

I'm sure you left off "male" in front of "sex offenders" for the sake of brevity. Also, "we" do castrate sex offenders! One can be voluntarily castrated. You're not really asking "why don't we involuntarily castrate male sex offenders?" are you, Professor? I'm afraid I'm right up against the edge of mansplaining here.

Wiki: Chemical Castration

HoodlumDoodlum said...

Your castration question is more interesting, I think, reversed: let's assume it's determined that a certain type of bariatric surgery is successful at massively reducing obesity but that it usually also removes the pleasure of eating from the individual. Further assume we're all paying for health complications of the unwell, either through the current health care subsidies/Obamacare or through the long-awaited single payer system.
Now. We definitively establish that the cost of extreme obesity is $X and that the cost savings of this bariatric surgery are large, say $8X. Many obese people, though, do not want to get the surgery--they'd rather be obese and happy than non-obese and unhappy, and besides they do not bear the majority of the direct costs of their unhealthy existence (assuming subsidized or "free" health care).
Ok. Can we at that point force the obese person to have the surgery? Presumably no--"their body, their choice" or something like it. Fine. Can we at that point present them with the choice of either having the surgery or paying for their own health costs? If so what do we do when the obese individual is broke--can they be denied care altogether at that point? What level/amount of coercion would be legally permissible in such a situation?

Birches said...

I have seen plenty of very obese people eat peanut butter cups. They don't act like they are having an organism, more like they ate the package in one bite before they even comprehended the taste. Thinner people seem to take more time with their food.

My sister had bypass surgery over 15 years ago. She was always overweight, but never morbidly obese and could not lose weight normally. She tells the story that one year in college, she ate only two cans of pineapple everyday for food; she was still a size ten.
She decided she wanted the surgery and gained a bunch of weight to qualify. She's still thin and does triathlons now.

Ron said...

[sings to the tune of "Don't Cry For Me Argentina"]

Don't cry for me, Emerita,

It's true you're not now in a classroom,

Please keep on posting, that's our insistance...

~ Gordon Pasha said...

I'm an endocrinologist. I don't see these patients post op for their diabetes, but I still see them for micronutrient disorders and the complications thereof. Life is a balloon, you push in at one spot, and it will bulge at another.

Fred Drinkwater said...

Paco :
Airframe & Powerplant?

tcrosse said...

Emerita, meter maid.

Karen said...

Since I started bright line eating with no sugar and no flour , the weight-loss has been dramatic with no surgery needed. The first few days are kind of tough but after that life sails on and my enjoyment of the taste of food has grown and not diminished. I certainly recommend it rather than surgery which is invasive and has lots of side effects and is most often not effective. The most interesting side effect of my new lifestyle is that my brain has cleared up. Prior to beginning this program, I had begun to think that my intellect was diminishing with age, but it was really the brain fog caused by sugar, highly processed foods and addictive eating.

Edmund said...



Some interesting science here. Gut microbiome has been shown to be very influential in diabetes and weight gain. Rodent studies have shown that certain intestinal flora can cause them to gain weight on a diet that the control group didn't gain weight on. In addition, some human cases have been found that a fecal transplant from an overweight person to a normal weight person can cause obesity. It appears that some gut bacteria can manipulate the hormone systems in the body that regulate insulin.

A while back, I saw a time sequenced map of obesity rates in the US by county. It looked like an epidemic map. A cluster in Appalachia, spread through the South, outbreaks on the coasts. If gut bacteria can cause obesity - even on a calorie restricted diet - then it might be we have seen an actual epidemic. And by manipulating the microbiome we might be able to "cure" it.

CStanley said...

@Karen- hubs and i are starting a similar plan next week and I'm interested in advice. I get what not to eat but need to figure out what we can eat that we will enjoy and stick to. Past efforts have proven difficult with all the extra shopping and prep time.

We're looking at "Eat Fat, Get Thin" by Mark Hyman. Did you use any specific diet or plan? My biggest concerns are that the intro period is very low carb and I tend to not adjust well, and that two of his go-to good fat foods are salmon and avocados and i cant stand either of those. Im planning to do other fishes like black cod and halibut, but looking for other ideas.

Bill Peschel said...

"There's a huge financial interest in performing all this surgery..."

You're not kidding. A friend of ours saw her doc recently, and he said they recommend this surgery if you're 100 pounds overweight.

Considering that my 6' frame is supposed to be 157 pounds and I used to be 235 at my worst, I wasn't too far off from qualifying for severe surgery that really screws over your body.

That's scary.

protestmanager said...

There's a good deal of research showing that your gut microbiome has significant influence on how much you eat, that fat people's microbiomes essentially work to sabotage weight loss attempts, that bariatric surgery leads to a change in your microbiome that encourages weight loss, and that fecal matter transplants can have 80 - 90% of the positive effect of bariatric surgery, at a significantly lower cost.

Yes, it's icky. Yes, it's weird. So is biology.

Fred Drinkwater said...

CStanley, Karen,
Speaking from just my personal experience, I noticed that essentially eliminating wheat from my diet after age 50 made a huge (yuge?) difference in my gut-fat. Other grains don't seem to have the same fat-accumulating effect on me, so I still eat a lot of corn and oats.
I eat a small very-high-protein meal, usually fish, right after extended exercise, e.g. following a 30+ mile ride. My weight's been stable within a +- 5 pound range since I was 20.

jrapdx said...

Always an interesting subject. I ran a medical weight loss clinic for several years, and have seen numerous post-surgical patients later on. Obesity is an extremely complex problem, we don't know nearly enough.

Bariatric surgery may at times be a necessary last resort but it's a crude, primitive measure. "Side-effects" are decidedly not benign. All the post-surgery patients I've seen had over time developed profound, in some cases even disabling nutritional deficits.

One issue is the studies declaring surgery "safe and effective" have been done by the people or programs doing the surgery, no wonder results are so positive. Truly independent, unbiased data is hard to come by.

IMO at some point in the future when we understand the condition of obesity well enough to treat it properly, hacking obesity surgically will be looked at in the same way we now look back on lobotomy in the 1940's.

urbane legend said...

Ahhh, Reese's Peanut Butter Cups; food of the gods. Any gods who deny this aren't worth my time.

Clyde said...

Do you like Gina Kolatas and getting caught in the rain?

Jon Ericson said...

Very good Clyde.
Here, have a small rodent.
It's on the house!

urbane legend said...

No, Clyde, not together. Gina Kolatas and Peanut Butter Cups do not go together, much less with rain. And I'm not into health food. The brain question depends on who you ask, and I say most of them are wrong. ( Great pun )

Unknown said...

They promote this surgery as if it is a sure thing. There is a significant risk. I know someone who, after the surgery, had their intestines die and they had to be removed. From now on they can only eat this very very expensive medical food paste, like thousands of dollars per month. People die. Others slowly gain weight back.

Unknown said...

They promote this surgery as if it is a sure thing. There is a significant risk. I know someone who, after the surgery, had their intestines die and they had to be removed. From now on they can only eat this very very expensive medical food paste, like thousands of dollars per month. People die. Others slowly gain weight back.

bcorig said...

I use metaphors to explain complicated concepts to patients.