Just eat less . . . oh and hang a bag of (blank) around your neck. Another interesting bash...

Here we go again, brothers! And to think, all we needed to do was hang a bag of sh*t around our necks and eat less! Shucks. Who'd a thunk it? --------------------------------------------- November 18, 2007 Freakonomics   The Stomach-Surgery Conundrum By STEPHEN J. DUBNER and STEVEN D. LEVITT Bariatric Surgery Deborah Kattler Kupetz is a Los Angeles businesswoman and mother of three who tries to watch her weight. That’s why she recently bought two lifelike plastic models of human body fat from a medical-supply company, a one-pound blob and a five-pound blob, and put them on display in her kitchen. By doing so, Kattler Kupetz wouldn’t seem to have mu*****ommon with Han Xin, a legendary Chinese general who lived more than 2,000 years ago. But she does. Upon entering one battle, Han assembled his soldiers with their backs to a river so that retreat was not an option. With no choice but to attack the enemy head-on, Han’s men did just that. This is what economists call a commitment device--a means with which to lock yourself into a course of action that you might not otherwise choose but that produces a desired result. While not as severe as Hans strategy, Kattler Kupetz’s purchase of those fat blobs was a commitment device, too: every mealtime, they force her to envision what a few extra pounds of fat looks like. It is hard to think of anyone who employs commitment devices as avidly as the overweight American. Perhaps you once bought a yearlong gym membership or had a three-month supply of healthful meals delivered to your doorstep. Maybe you joined friends in a group diet or even taped your refrigerator shut. The popular new weight-loss pill Alli, which partly blocks the body’s absorption of fat, is a commitment device with real consequences: a person who takes Alli and then eats too much fatty food may experience a bout of oily diarrhea. So how are all these commitment devices working? Not very well. According to the Centers for Disease Control, one out of every three American adults is obese. Which is why so many people have begun to embrace a far more drastic commitment device, one that Han Xin himself would probably applaud: surgery. This year, more than 200,000 weight-loss, or bariatric, operations will be performed in the United States, a nearly ten-fold increase in just a decade. The most prominent types are gastric bypass and laparoscopic adjustable gastric banding (or “Lap-Band”), although there are a few others. Each one works a bit differently, but the general aim is to reduce the stomach’s capacity and thereby thwart the appetite. If all goes well, bariatric surgery leads to substantial weight loss, especially among the morbidly obese. Marc Bessler, director of the Center for Obesity Surgery at New York-Presbyterian/Columbia University Medical Center, is an innovator in the field who personally performs about 200 bariatric operations a year. Because his own father was morbidly obese, Bessler brings a personal zeal to his work. “The whole time I was growing up, he was so overweight he couldn’t play ball with us,” he says. “He died at age 54 from colon cancer. It may have been picked up late because of his obesity.” Bessler acknowledges that bariatric surgery has a checkered history. “In the past, it killed people, and it didn’t work,” he says. “In the late 1950s and early 1960s, even though it was effective for weight loss, there was lots of complications and mortality. Then in the late ‘70s and early ‘80s, there were much better surgeries, but they didn’t really work that well. The weight would start coming back.” Technological innovations, especially the use of laparoscopic procedures, have made for considerable gains in safety and efficacy. While the operation is still dangerous in some cir****tances --one study found that for a surgeon’s first 19 bariatric operations, patients were nearly five times as likely to die than patients that the surgeon later operated on--the overall mortality rate is now in the neighborhood of 1 percent. But even if bariatric surgery doesn’t kill you, there are things to worry about. The operation often produces complications “ physiological ones, to be sure, but also perhaps psychological ones. A significant fraction of postbariatric patients acquire new addictions like gambling, smoking, compulsive shopping or alcoholism once they are no longer addicted to eating. In certain cases, some people also learn to outfox the procedure by taking in calories in liquid form (drinking chocolate syrup straight from the can, for instance) or simply drinking and eating at the same time. Surgery is also a lot more expensive than even the most lavish diet, with a Lap-Band procedure costing about $20,000 and a gastric bypass about $30,000. But Bessler and other bariatric advocates argue that the upsides outweigh the downsides, especially for a morbidly obese patient whose quality of life is already suffering. While asking a bariatric surgeon if bariatric surgery is a good idea might seem akin to asking a barber if you need a haircut--in fact, Bessler does consult for companies in the industry--the data seem to back up his claims: not only do most patients keep off a significant amount of weight but the other medical problems that accompany obesity are also often assuaged. One recent analysis found that 77 percent of bariatric-surgery patients with Type 2 diabetes experienced ?complete resolution? of their diabetes after the procedure; the surgery also helps eliminate hypertension and sleep apnea . From an economic standpoint, research suggests that the operation can pay for itself within a few years because a postbariatric patient now requires less medical care and fewer prescriptions . That’s why some insurance companies cover bariatric surgery ? as more do, it will likely lead to a further spike in the volume of operations. This is especially good news for the hospitals that have already grown dependent on the significant cash flow that bariatric surgery generates. There are at least two ways to think about the rise in bariatric surgery. On the one hand, isn’t it terrific that technology has once again solved a perplexing human problem? Now people can eat all they want for years and years and then, at the hands of a talented surgeon, suddenly bid farewell to all their fat. There are risks and expenses of course, but still, isn’t this what progress is all about? On the other hand, why is such a drastic measure called for? It’s one thing to spend billions of dollars on a disease for which the cause and cure are a mystery. But that’s not the case here. Even those who argue that obesity has a strong genetic component must acknowledge, as Bessler does, that “the amount of obesity has skyrocketed in the past 30 years, but our genetic makeup certainly hasn’t changed in that time.” So the cause is, essentially, that people eat too much; and the cure is, essentially, to eat less. But bariatric surgery seems to fit in nicely with the tenor of our times. Consider, for instance, the game shows we watch. The old model was “Jeopardy!,” which required a player to beat her opponents to the buzzer and then pluck just the right sliver of trivial knowledge from her vast cerebral storage network. The current model is “Deal or No Deal,” which requires no talent whatsoever beyond the ability to randomly pick a number on a briefcase. Maybe the problem is that despite all the diets and exercise regimes and gimmicks that have been put into play during our national bout of obesity, the right nonsurgical solution simply hasn’t yet been found. So here’s a suggestion: Hang around your neck a small Ziploc bag containing a towelette infused with an aroma of, well, of something deeply disgusting. (In the interest of not offending anyone who happens to be reading this over breakfast, we won’t offer specific suggestions, but you can surely conjure a horrid odor on your own.) Every time you're about to open the refrigerator or look over a menu, unzip the bag and take a whiff. Now that’s a commitment device. Stephen J. Dubner and Steven D. Levitt are the authors of “Freakonomics.” More information on the research behind this column is online at www.freakonomics.com. Copyright 2007

Although I don't know either of the authors personally, I venture to say neither of them have ever had a significant weight problem.  It's real damn easy for someone to walk up to you and say "why don't you just eat less" when they have no idea what you've been though. 

I've had the same experience with never-been-fat people not understanding. Too bad they can't figure out that if it were that easy there'd be no fat people!

Gpd what jackasses....I hope someone ties a bag of sh*t around their necks and see how they like it. Scott

Scott, Be careful what you wish for--some people seem to enjoy a good bag of sh*t now and then.

Hey Doug,

Didn't Scott do that with **** and ice cream?

Dave

Dave, I don't know and I don't want to know.

I've read Freakanomics (the Dubner/Levitt book) and thought it was good.  The close of this article is a bit harsh, but I don't think overall it was too negative.  They are basically doing what they always do: taking everyday problems and viewing them in the economics framework.  I myself viewed the decision to get surgery as an economic decision, a cost/benefit analysis assigning value to the likely gains and cost to the risks and drawbacks.  Is their a bit of fat bashing in their?  Sure.  I guess I'm not as sensitive to that as lots of people on here are.  Ultimately, as they themselves pretty much concede, the surgery often passes the cost-benefit test.  They may chide those who need it, but I guarantee you as an economist myself that they'd get it themselves right away if they found themselves meeting the criteria.

I also read Freakonomics and enjoyed it thoroughly. It's interesting and informative. I'm not sure my annoyance at the last part of the article is sensitivity as such or just fatigue regarding the persistent cheap shots at fatties. And I believe I can use the  "other f-word" as a former SMO currently borderline obese-guy heading for overweight and victory! I'm sensitive to the ignorance behind all the nanny-state programs designed to "solve" the obesity epidemic. Will-power can't trump everything and being obese isn't a moral failure to be whipped into shape by do-gooders and look-downers. Dubner and Levitt were probably being ironic and clever rather than snotty. Still, a cheap shot is a cheap shot. But, guys, read their book. It is a good one.

Jim P's First Law Of Human Behavior proved once again: The worst thing about ignorance is its insistence.