Saturday, March 5, 2011

Stomach Partitioning

There are two articles in the latest Archives of Surgery that compare different techniques of bariatric surgery in terms of long term efficacy. (If you're interested, the more complex gastric bypass seems to lead to better diabetes control and quality of life compared to other techniques.) One paper was from Taiwan, the other from Wisconsin. I didn't realize Taiwan had such a problem with Chalupas. But it's true, apparently Taiwan has seen an increasing rise in obesity over the past two decades (that's what you get for aligning with America over the Chinese mainland!). Wisconsin, well, that's where all the Cheeseheads are.

But it's amazing to me the number of bariatric papers that get churned out every year by major surgical journals. It's really difficult to read Archives or Annals or JACS on a month to month basis without seeing at least one paper devoted to bariatrics.

Is this a good thing? Is this science on the march? Are we monthly witnesses to the ineluctable forward thrust of the scientific method in human endeavor?

The bariatric lobby has won the war I suppose. You no longer read dissents that question the philosophical nature of the "disease" of obesity and the appropriate steps a society ought to take to remedy it. The more papers they can manufacture touting the efficacy of chopping your stomach up into various new shapes and forms, the more they can avoid the fundamental question of means and skip ahead to ends. Obesity surgery works. But we've stopped asking why obesity exists to such a grave extent. The ontological nature of obesity has been buried under an avalanche of teleology.

Are we so resigned to the epidemic of morbid obesity that we no longer hope to change human behavior or the way we provide food on a massive scale? Have we become passive reactants to a national health scourge, offering only the option of anatomic rearrangement?

I've always felt that bariatric surgery ought to be an esoteric, poorly understood specialty, where patients were only rarely referred due to underlying metabolic or genetic abnormalities. I never thought it would flourish, sustainably, like the way it has. Surgery departments at major tertiary centers all have their own bariatric programs. The casual prevalence of such a development ought to astound us all.


Anonymous said...

Yeah, creeps me out too.

Gets a little tough later on if these people get really sick, and have a stomach the size of a pea...


rlbates said...

Me, too. Sure wish this surgery wasn't becoming more and more common.

Anonymous said...

Glad to see you posting more again. I enjoy your insight.

Med Student, Texas

DIY Health said...

Yes, the field that was once thought to be a real "specialization" now becomes an ordinary thing.. Ah, for the love of cheeseburgers...

Anonymous said...

The same could be said of a number of things in general surgery: why not focus patients on high fiber diets rather than resorting to sigmoidectomies for diverticulitis? why not prevent people from smoking before they need a pneumonectomy or a god-awful Whipple? When did we become resigned to hacking out someone's pancreatic head for a marginal chance at living slightly longer with pancreatic CA, even though their ICU stay may make up a decent part of that extended life? At least with Bariatric Surgery, humongous individuals will see dramatic results that they would not achieve on their own! At least those are my thoughts; appreciate the article!

Anonymous said...

I unfortunately am a nurse on a surgical floor of a 'bariatric center of excellece'--which simply means that Medicare and Medicaid will now pay for gastric bypass and banding for patients with a BMI over 35-40 and comorbid conditions.
I love my most of my surgical patients, but truly despise the idea of the bariatric surgeries. The patients who are supposedly so well informed get mad at us nurses who "deny" them food post op. Um, really? Did you not read that you'll be on a sugar-free clear liquid diet for the first week?? No solid foods for at least one month.
While I understand the previous anon poster's point that there are non-surgical treatments for many of the common surgeries, I also understand that if a person is actually able to maintain the required diet, surgery or none, he or she WILL lose weight.
I will remain Anon for the sake of my job.