Round, Round, Round, part 2

Predictably, there is some pushback to the NYT article about the wretched long-term results for The Biggest LoserThe Washington Post shot back with

https://www.washingtonpost.com/news/wonk/wp/2016/05/05/why-the-weight-loss-study-everyone-has-been-sharing-is-kind-of-misleading/

I was, frankly, a bit surprised by the moderate tone of the WaPo article. Sure, it (as did the NYT piece, though even more briefly) argue for bariatric surgery, citing a study that showed the the metabolic kickback that follows bariatric surgery disappears after a year. Which is interesting, though it only tracks one aspect of post-surgical affects.

The TBL folks are, indeed,”outliers” as the WaPo article says, which is why they are both deeply relevant to the larger discussion and irrelevant at the same time. Relevant because they have been driven into what amounts to functional eating/exercise disorders during their tenure on the show, which is not at all unlike what many “medically supervised weight loss programs” do.

There are several new bariatric procedures–all considerably less invasive than the standard ones (and mostly not covered by insurance, of course). There’s the Gastric Balloon, in which a saline-filled silicone balloon that’s inserted in stomach for 6 months. There’s AspireAssist, which is kind of gross, in which a sort of tube-and-valve system is implanted that allows the patient to physically dump about a third of what she/he consumes directly from the stomach–this one sounds like a medically supervised form of bulemia to me, but I suppose it’s considerably easier on the esophagus and teeth. There’s one called vBloc which involves a pacemaker-ish thingy that’s plugged into a part of the lower stomach where nerves control appetite. It’s kind of a TENS unit for your appetite, a neuro-regulator. It claims a truly tiny complication rate. And there’s Bariatric Emobolization, in which an interventional radiologist implants teeny beads at the end of veins leading to that same appetite controlling area of the stomach. Also interesting–esp since cardiologists have been using a similar procedure for enough years to have some idea of how it works.

All these procedures are out-patient and only involve Versed or similarly lightweight anasthesia, which is a good thing. I got pretty excited, in truth, about the vBloc, until I read that having a hiatal hernia takes you out of the running for it. But, supposedly, I could get my occasionally very painful hiatal hernia repaired (which I gather, might also cut down on heartburn, so maybe…). Oh yeah, it also requires, at least according to the web page, that I have undergone a “medically supervised weight loss program” before trying it, which is just bullshit.

Maybe these procedures will pan out. They’re all new enough not to have serious longitudinal studies done. That being said, I am kind of tired of my own heft and the whackadoo cycle of depression that leads to not exercising that leads to eating really badly that leads to feeling shitty about myself. Decades of therapy have not dislocated that cycle, and no amount of body-positive discourse is going to dislodge it. Watching my skinny mother slide into dementia has added an absolute terror of Alzheimer’s to my psycho-cognitive atmosphere (I also have rosacea, which apparently indicates an increased likelihood for Alzheimer’s–like having zits at 60+ isn’t enough of a bummer), so the weather is getting kind of stormy up there, which feeds the depression, and so forth, and so on. Fuck it.

Lots to think about (well, definitely not the one with the valve-thingy). So here I am wallowing in what feels a bit like hypocrisy because I have spent so much time on the blog railing against bariatric surgeries (I still find the violence involved a difficulty on many levels). But these are “procedures,” not “surgeries,” and that’s a big difference.

And I will admit that I have been profoundly disturbed by the discovery that organ donor programs don’t want mine because of my weight and the “black fat” that surrounds them. Until they get the growing-livers-in-petrie-dishes thing worked out, I’m kind of attracted to the idea of my bits helping someone else hang in there. I know it’s a funny thing to be focusing on, but there you go.

No conclusions here. TBL is still evil. Weight loss/management is still mysterious and overwhelmingly mistreated by the medical community. The body-positivity and health-at-any-size movements are still good things, especially for younger humans who can still be taught not to regard themselves as monsters. And I am still here and trying to figure out how to have a body.

 

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