Never ask a question if you don't already know the answer
Well, I'm not a "real" lawyer, in the sense that I'm a patent attorney -- that's a scientist who goes over to the Dark Side. In reality, I'm more scientist than lawyer, and I am an advocate of the DS procedure, and I use my legal knowledge to help people get insurance approval for the DS (and sometimes for other procedures as well) -- pro bono.
One of the things I do is help point out the benefits of the DS over other surgeries. As I'm sure you know, this frequently causes "Surgery Wars" when some people don't like to hear the facts I post -- they take my posts about the benefits of the DS to be an attack on themselves personally. Whatever -- I don't care, so long as the information about the DS gets out to pre-ops and potential revision patients who are still doing their research. I don't care what surgery they get, just that they have ALL the correct information available to them before they make their choice.
Several weeks ago, I tried to enlighten "ValueMe" about some factual information -- scientific and medical publications, mind you -- regarding the difference in success with WLS between AAs and Caucasians. I will post those abstracts below, but the gist of it is that AAs consistently do less well than Caucasians with Lapband and RNY. For this reason, I often suggest that AAs look carefully at the DS. Information is power.
Well, if you recall, ValueMe has decided that my posting of this INFORMATION is RACIST in motivation and in fact. See this thread (http://www.obesityhelp.com/forums/bmi_over_50/3856585/Denial -It-aint-just-a-river-in-Egypt/), which contains her repetition of this accusation, including an allegation that most of the people on this Forum agree with her position.
So, here is my question -- and yes, I don't know what you are going to say, which is why I am asking it in the first place: DO YOU THINK MY POSTING OF THESE ABSTRACTS IS RACIST? I really do want to know -- and if so, why you think so. And I don't care about being surprised or embarrased by your answers.
Here are the abstracts:
1: Obes Surg. 2008 Jan;18(1):39-42. Epub 2007 Dec 15.
The impact of race on weight loss after Roux-en-Y gastric bypass surgery.
Harvin G, DeLegge M, Garrow DA.
Department of Medicine, Division of Gastroenterology and Hepatology, Digestive Disease Center, Medical University of South Carolina (MUSC), 96 Jonathon Lucas Street, CSB #210, P.O. Box 250 327, Charleston, SC, USA.
BACKGROUND: Gastric bypass surgery for morbid obesity has dramatically increased in volume over the past decade. Caucasian patients have been noted previously to lose more weight after bariatric surgery than African-Americans patients. Data regarding predictors of maintaining weight loss after surgery are minimal. We sought to determine predictors of long-term weight loss after bariatric surgery. METHODS: Retrospective analysis using a multivariate logistic regression model of all patients undergoing Roux-en-Y gastric bypass surgery at the Medical University of South Carolina from May 1993 to December 2004 for whom 2 years of follow-up data was available. Our dependent variable was the percentage of weight lost from baseline, dichotomized at +/-35%. Our primary independent variable was race, defined as Caucasian, African-American, or other. Relevant covariates were added to the model to control for their potential effects on outcome. RESULTS: One hundred eleven patients (17 male/94 female; 85% Caucasian, mean age 44 years (range 18-68 years). In our model, Caucasian subjects (adjusted odds ratio [OR] = 7.60, 95% confidence intervals [95%CI] = 1.83-31.5) and late post surgical complications (adjusted OR = 2.67, 95%CI = 1.05-6.80) significantly predicted weight loss at 2 years, after controlling for relevant confounders. Other covariates did not significantly impact the model. CONCLUSION: Race and late post surgical complications significantly impacted the percentage of weight loss at 2 years for patients undergoing Roux-en-Y gastric bypass surgery at our institution. Future research should be directed at determining potential genetic and/or social reasons for these differences.
1: Obes Surg. 2007 Apr;17(4):460-4.
Are African-Americans as successful as Caucasians after laparoscopic gastric bypass?
Madan AK, Whitfield JD, Fain JN, Beech BM, Ternovits CA, Menachery S, Tichansky DS.
Section of Minimally Invasive Surgery, Department of Surgery, University of Tennessee Health Science Center, 956 Court Ave., Room G210, Memphis, TN 38163, USA. amadan@...
BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) has been demonstrated to provide weight loss comparable to open gastric bypass. It has been suggested that African-Americans (AA) are not as successful as Caucasians (CA) after bariatric surgery. Our hypothesis was that AAs are just as successful as CA after LRYGBP in terms of weight loss and comorbidity improvement. METHODS: A retrospective chart review was performed on all AA and CA patients who underwent LRYGBP for a 6-month period. Success after LRYGBP [defined as (1) 25% loss of preoperative weight, (2) 50% excess weight loss (EWL), or (3) weight loss to within 50% ideal weight] was compared by ethnicity. RESULTS: 102 patients were included in this study. 97 patients (30 AA patients and 67 CA patients) had at least 1-year follow-up data available. Preoperative data did not differ between both groups. There was a statistically significant difference in %EWL between AA and CA (66% vs 74%; P<0.05). However, there was no ethnic difference in the percentage of patients with successful weight loss (as defined by any of the above 3 criteria). Furthermore, there was no statistical difference between the percentages of AA and CA patients who had improved or resolved diabetes and hypertension. CONCLUSIONS: LRYGBP offers good weight loss in all patients. While there may be greater %EWL in CA patients, no ethnic difference in successful weight loss exists. More importantly, co-morbidities improve or resolve equally between AA and CA patients. LRYGBP should be considered successful in AA patients.
1: Obesity (Silver Spring). 2007 Jun;15(6):1455-63.
Weight loss and health outcomes in African Americans and whites after gastric bypass surgery.
Anderson WA, Greene GW, Forse RA, Apovian CM, Istfan NW.
Section of Endocrinology, Diabetes and Nutrition,
OBJECTIVE: The objective was to describe differences in weight loss, dietary intake, and cardiovascular risk factors between white and African-American patients after gastric bypass (GBP). RESEARCH METHODS AND PROCEDURES: This was a retrospective database review of a sample of 84 adult patients (24 African-American and 60 white women and men) between the ages of 33 and 53 years. All subjects had GBP surgery in 2001 at the Bariatric Surgery Program at
1: Obes Surg. 2006 Feb;16(2):159-65.
Ethnic differences in obesity and surgical weight loss between African-American and Caucasian females.
BACKGROUND: In the general population, African-American females are more obese and resistant to weight loss than Caucasian women. In the present study, we examined the severity of obesity among morbidly obese African-American and Caucasian females, studied the effectiveness of Roux-en-Y gastric bypass (RYGBP), and sought to identify factors contributing to obesity and weight loss. METHODS: The study population included 153 morbidly obese females randomly selected from our general bariatric patient population. Anthropometric measurements consisted of body weight, body mass index (BMI), excess weight, and waist, hip, thigh, and neck circumferences. Factors that may contribute to obesity included age, age of obesity onset, number of childbirths, calorie intake, diet composition, and degree of psychological distress. The effects of RYBGP were studied in weight-matched groups of African-American and Caucasian females (n=37 per group) at weight loss nadir, i.e. 12 to 18 months after surgery. RESULTS: We found that morbid obesity is more severe among African-American than Caucasian females. The greater degree of obesity of African-American, as compared to Caucasian, females is not due to ethnic differences in calorie intake, diet composition, age or age of obesity onset, number of childbirths, and psychological distress. RYGBP is less effective in reducing body fat and, consequently, excess body weight of the African-American than the Caucasian females, suggesting possible ethnic differences in fat metabolism. CONCLUSION: African-American females with morbid obesity have greater adiposity than do Caucasian women and lose significantly less body fat after RYGBP.
1: J Assoc Acad Minor Phys. 2001 Jul;12(3):129-36.
Bariatric surgery for severe obesity.
Department of Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia 23298-0519, USA. hsugerma@...
Severe obesity is associated with multiple comorbidities and is refractory to dietary management with or without behavioral or drug therapies. There are a number of surgical procedures for the treatment of morbid obesity, including purely gastric restrictive, a combination of malabsorption and gastric restriction or primary malabsorption. The purely gastric restrictive procedures, including vertical banded gastroplasty and laparoscopic adjustable silicone gastric banding, do not provide adequate weight loss. African-American patients do especially poorly after the banding procedure with the loss of only 11% of excess weight in one study. Gastric bypass (GBP) is associated with the loss of 66% of excess weight at 1 to 2 years after surgery, 60% at 5 years and 50% at 10 years. For unknown reasons, African-American patients lose significantly less weight than Caucasians after GBP. There is a risk of micronutrient deficiencies after GBP, including iron deficiency anemia in menstruating women, vitamin B12, and calcium deficiencies. Prophylactic supplementation of these nutrients is necessary. Recurrent vomiting after bariatric surgery may be associated with a severe polyneuropathy and must be aggressively treated with endoscopic dilatation before this complication is allowed to develop. The malabsorptive procedures include the partial biliopancreatic bypass (BPD) and BPD with duodenal switch (BPD/DS). The BPD appears to cause severe protein-calorie malnutrition in American patients; the BPD/DS may be associated with less malnutrition. Weight loss failure after GBP does not respond to tightening a dilated gastrojejunal stoma or reducing the size of the gastric pouch. These patients may require conversion to a malabsorptive distal GBP, similar to the BPD. However, because of the risk of severe protein-calorie malnutrition and calcium deficiency BPD should be reserved for patients with severe obesity comorbidity. The risk of death following bariatric surgery is between 1% and 2% in most series but is significantly higher in patients with respiratory insufficiency of obesity. In most patients, surgically induced weight loss will correct hypertension, type II diabetes mellitus, sleep apnea, obesity hypoventilation syndrome, gastroesophageal reflux, venous stasis disease, urinary incontinence, female sexual hormone dysfunction, pseudotumor cerebri, degenerative joint disease pains, as well as improved self-image and employability.
By the way, ValueMe claims to be a lawyer too -- I am particuarly curious to know whether her characterization of the support she believes she has from this community is factually based.
on 2/14/09 1:26 am, edited 2/14/09 1:33 am - Northern, VA
Gee the good stuff comes up when I have no time to respond to a lot of posting, but I will give you my honest opinion on these "studies", I DO find them a bit biased and skewed, it's just like suggesting that if we are black we are more prone to many illness.
That is like saying ALL blacks will get diabetes, sickle cell, heart disease or high blood pressure just because they ARE black. That said, it is each individual lifestyle and genetics that makes someone more prone to these illness.
I am a black female in my 40s and I DON'T have high blood pressure or diabetes even when I was obese I did not have that perhaps because I don't eat a lot of pork, my family DOES have a history of high blood pressure, strokes and so forth but my parents and their parents consumed a lot more pork that I do.
My point is just because you are black does not MEAN you should get a more drastic weight loss surgery just because you are more prone to failure with traditional less invasive surgeries. Weight loss surgeries SHOULD apply to ALL races...if you are willing to make a commitment to lifestyle change, exercise and DIET ANY SURGERY should work REGARDLESS of race, ethnicity, religion or so forth-- just peek at the lap band forum and RNY forums and see how BOTH BLACK and WHITE are struggling....because they are tools and we have to work them regardless of our skin color or ethnicity.
This type of talk will make blacks folks feel inferior; if that was the case there would not be black attorneys, doctors, scientists and, software developers like me
we would just give up and think we CAN'T because we are black. But I do get your point, but I respectfully disagree.
ETA: I did not read the last portion of your post, do I personally think you are a racist? I really don't know, so I can't honestly answer that question, but I do hope you are posting these "findings' and studies with GOOD INTENT.....it is ok to education people about the DS surgery, I think MOST people who look into weight loss surgery SHOULD know all their options if they don't they should not get ANY surgery in the first place...it is a great thing that we ALL have surgical options regarless of skin color and I think most of us pick a surgery that they can live with the rest of their lives...I guess what we should advocate is education and research, I am sure the DS is a great surgery, and works for many... so does RNY and LAP BAND and the Sleeve as adults we picked the surgery that fit our needs, health and lifestyle.
My 2 cents.
What are you suggesting??? That factual information about racial differences in biology will make people feel inferior?? If that isn't ridiculous on its face, I will admit to being utterly flabbergasted by the kind of thinking that suggests. Do you feel like it is some sort of moral failing to believe these statistics? Does it affect YOUR personal belief about your own abilities to succeed with your WLS?
Do you not "believe" that AAs have a higher frequency of sickle cell disease? That they have a higher incidence of high blood pressure -- and that different medicines work better for AAs in lowering their bp than ones that generally work better for Caucasians and other races? Is it racist to prescribe different bp medications for AAs??
What do you mean by " Weight loss surgeries SHOULD apply to ALL races ... "? You think there is something racist in observing the statistics that restrictive-only or only slightly malabsorptive surgeries generally work less well for AAs? Is there some conspiracy involved in suggesting that AAs generally will do better with more malabsorptive procedures? Do these statistics mean that you personally don't have the right to believe you can "work your tool" and succeed?
Should I feel discriminated against because I am of Jewish ancestry, and thus I am subject to carrying and passing on the genes for Tay Sach's, Nieman-Pick, Canavan and some other metabolic diseases? Should I tell my children (since I am past child-bearing age) NOT to be tested for carrying the genes for these diseases because it is RACIST to suggest that their children might be at risk? This is utter nonsense to me.
Diana since being dxd with Multiple Sclerosis, another group member and I have basically dedicated our lives at getting the RIGHT INFORMATION out there so that A/A's do not have to suffer. Someone came up with the bright idea that A/A's do not get MS. It is said that only Caucasians do. Instead A/A's are clumped into the Lupus catagory due to the two diseases being very similar. Once Dr.'s are finally convinced that an A/A patient does have MS, great damage has already been done. This is all due to mis-information, not racism.
Here is our latest interview with the MS Foundation.
http://www.virtualonlinepubs.com/publication/?i=11900 (pages 15-16) I wonder if after reading the comparisons made in regards to Multiple Sclerosis in A/A's VS. Caucasians, will someone percieve the article as racist? probably so, when all we are trying to do is correct some mess that some "proffessional" has made which has cost many lives. More A/A's have died from MS complications than anyother ethinic group.
Strangers have come right on this board up in arms saying that having a separate forum is racist towards Caucasians here on OH. One point that is always made is that there are issues that we as A/A's face as an ethnicity. Skin, hair, socio economic issues and other factors play a huge role in why this forum is warranted. The research that you present makes the same point.
Again I thank you for your work, because if you, your collegues, and scientists did not do the work then I suppose that no one would.
Que
Join us here: http://www.obesityhelp.com/forums/wls_lightweights/
Thank-you for having Integrity.
No matter what you say, it has to be her way! Research also tells us that STRESS is the silent killer and it the motivation behind diseases like, high blood pressure, heart disease..., I know Black Women who have Physcian diagnosed Stress related diabetes, asthma... STRESS even exacerbates diseases like Sickle Cell Anemia, psorisis...
Now, how is STRESS diagnosed? It CAN"T BE, ONLY the RESULTS can be diagnosed and treated (those above illnesses I've mentioned and more). People with a Band will even tell you that their Band acts different when they are under Stress..you can't Measure that only the Results!
My POINT is that African American LIVE ON A DAILY BASIS in a HIGH Stress Environment. Stress is why heart attack is the leading cause of Women's dealth, NOW. So, Stress is Nothing to be played with! Being Black in America is like Living with a gun to one's head in many cases or like a ticking time bomb. That's Proven. Not only that, add the Poverty and you have Health factors that can't be measured...but what can be measured is the RESULTS of Poverty and Stress. So then the ILLUSION is that Blacks have this disease or that, or are more "prone to" this or that because of "genetic" factors...NOT Environmental Factors. Why, because Environmental Factors can be OVERCOME, genetic factors mean that you may be inferior. It's all a terrible game that people like Diana Cox use to Push Their point and agenda and try to make You (Us) seem "Crazy, "Stupid" or need her - and people like her to "educate" us.
That so called data does NOT take into consideration the STRESS of a single mother who has to choose between buying shoes for the kids, or buying some potatoes and eggs so the kids can eat for the rest of the month (I did't say asparagus or arugulla or yellow-finn fresh tuna)...we know what happens when anyone eats white potatoes( or most refined carbs-usually the cheapest food items to purchase and the worse for you health wise)>>>insulin rushes in the blood stream, triggering adipose (fat) cells operative>>triggering wt gain (basically). But this and other "data" DO NOT take Poverty and Stress into consideration, Only their Results!!! It's ALL a LIE and Game.
Be Well, Live Well
I Am Most Excellent - Affirmed Only Of GOD.
I wish for You, what I pray for Myself: Wellness, Happiness and Success In ALL Things Good!
I know for Sure I Control: My Attitude and Effort, My Health and Happiness.
on 2/14/09 1:29 am
I also know that with most studies the information can be skewed to present the info the researcher would like shown.
I think its a bit of a non-issue...Value Me has shown her true colors here as well and I think many take her posts with a grain of salt.
While I didn't opt for the DS I do believe you are doing the newbies a great service, while I might not neccessarily agree with all your tactics.
Have a great weekend!
,being that I am well familiar of the advocacy work that you do, knowing of many of those that you have helped, and in witnessing your online work have NEVER seen you discriminate, I will personally say NO.
Believe me when I say that this board has had its share of outright racist attacks but I wouldn't consider the posting of researched information racist. I want to personally thank you for the information because although it was my surgeon who suggested the DS for me, the information that you had readily available made my research much easier.
Que
PS. We just launched the chronic illness wls support group here at OH. I need to know if you have any documented information that might benefit members of the group?
Join us here: http://www.obesityhelp.com/forums/wls_lightweights/
Type 2 diabetes: there are lots of statistics demonstrating that the DS has the best cure rate of all of the weight loss surgeries, and the most durable -- with lapband and RNY, the disease often comes back when the weight does. I have references to support this.
Multiple Sclerosis: weight loss obviously helps with mobility. We have an MS patient in our local support group who swears that vitamin D supplementation to high normal levels is key to keeping symptoms in remission. But I don't have references for this -- I've never looked for them.
IBS: My personal information, coupled with LOTS of ancedotal reports (oddly, I've never seen a study, and not even a MENTION in the DS literature) is that my IBS got SO much better after my DS that had I known it would, I would have fought for the DS for this reason alone. My quality of life was VASTLY improved simply by the resolution of the worst of my IBS issues.
Kidney diseases: I frequently see where non-DS surgeons tell patients that the DS isn't appropriate for them, because DSers have to eat 80-100 g of protein/day. This makes me want to scream, it is so factually incorrect. The reason DSers have to eat lots of protein is so they absorb a SUFFICIENT (i.e., NORMAL) amount. Protein that is not absorbed does not affect the kidneys at all. It makes no biochemical or medical sense, but the patients don't know it, and they get dissuaded from getting the DS for the wrong (factually INCORRECT) reasons.
I'm not sure I'm answering the question you asked.
you are right on the money for what I would need. I can do the research and get the links based on what you just shared.
You are also right on the money about the MS patient. It has now been a proven fact that there is a direct link between Multiple Sclerosis and a deficiency in vitamin D. I've been taking 1000iu of Vitamin D for about 6 months and have noticed a huge difference in how I feel.
Thanks again.
Join us here: http://www.obesityhelp.com/forums/wls_lightweights/
,being that I am well familiar of the advocacy work that you do, knowing of many of those that you have helped, and in witnessing your online work have NEVER seen you discriminate, I will personally say NO.
Believe me when I say that this board has had its share of outright racist attacks but I wouldn't consider the posting of researched information racist. I want to personally thank you for the information because although it was my surgeon who suggested the DS for me, the information that you had readily available made my research much easier.
Que
PS. We just launched the chronic illness wls support group here at OH. I need to know if you have any documented information that might benefit members of the group?
