Great article on Bariatric surgery. My review on excerpts.

Great article on Bariatric surgery.  

My review on excerpts IN PURPLE

ONE

Good lead to the title of my book that I published last year. 

                                                                           

I guess the author never heard of :

The National Weigh Control Registry (NCWR) link

Very Low Calorie diets (VLCD) 800-1000 calories do counter hunger with ketosis in first 9-12 months. 

                      Remember that bariatric surgery does not affect the number of fat cells.  After 10 years 30% of bariatric patients regain their weight as the Sponge syndrome keeps their leptin low which causes decreased thermogenesis and increased hunger. 
                                                             
                                    TWO

THIS IS A GREAT ADVANCE. 

HOPEFULLY ALL STATES WILL EXPAND THEIR MEDICAID.

NOW THEY HAVE TO PAY FOR MULTIPLE DIET MEDICATIONS FIRST BEFORE SURGERY

MULTIPLE DIET MEDICATIONS.  LINK

THREE

The statement above is not accurate as it does not take into account the Waterfall Effect of all diet trials. 

FOUR

Again I think fails for many patients. Dr. Rosenbaum talks about 

'set point' here  link

FIVE

I think we have to  wait five years at least before we can say the bariatric surgery does actually do this.  The shrunken fat cells eventually win and cause weight regain.

No one addresses Sponge Theory  of mine.

SIX

The 3-9% re-operation rate for bypass and sleeve are major reasons to use  combination multiple diet medications first.

SEVEN

But how many gained their weight back?

It is a bias to not share the waterfall weight change of the whole group.

EIGHT

Exactly. 

"safe and effective" on average"

Not very encouraging for such an expensive operation that fails 30% of patients 

after 10 years they regain their weight with potential death.

NINE

TEN

ELEVEN

Very important 0.3% mortality risk

 and other potential harms. 

3 out of 1,000 patients will die.

TWELVE

EXACTLY. 

 MANY OF THE BARIATRIC TRIALS FLAWED.

I RARELY SEE 

INTENTION TO TREAT NUMBERS. 

 I HAVE TRIED TO WRITE AUTHORS FOR INFORMATION  AND THEY DON'T HAVE IT. 

THIRTEEN

My worry is that other than trials or large centers this long term follow up is not done

FOURTEEN 

FIFTEEN

This is his opinion.  

We now have multiple diet medications that can be taken at same time for life. 

Why risk being one of the three in 1,000 that die. 

SIXTEEN

GASTRIC LEAKS 5%

BARRETTS ESOPHAGUS 17%

SEVENTEEN

Suicide 

Drug and Alcohol disorders. 

EIGHTEEN