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Information, inspiration, coaching and support for obese people wanting a longer, healthier life through Weight Loss Surgery (WLS) |
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Thank you again for being one of the positive voices in my head. |
Through Thick and Thin #28 (September 1, 2003) Weighty Ethical Issues in Weight Loss SurgeryAs Weight Loss Surgery gains in both popularity and visibility, important ethical issues relating to the procedure are beginning to surface in the media and in public and medical forums. Two of the ethical issues being discussed most in the media are:
I sure don't have all the answers, but I will share below the messages that I'm hearing from the "still small voice" speaking from deep within my heart and spirit. WLS Qualification Policies: According to a recent article by Tara Parker-Pope, a reporter for the Wall St. Journal, more and more bariatric surgeons are finding that desperate patients who are rejected as WLS candidates because they're not 100 or more pounds overweight, or because their Body Mass Index is less than 40, are actively overeating so that they can qualify for the procedure. The present guidelines, the result of a 1991 National Institutes of Health consensus conference, will be reconsidered next spring by the American Society for Bariatric Surgery. Presently, in most cases, if a patient doesn't meet the strict guidelines, then even those insurers who normally cover WLS won't pay for the procedure, and doctors will often refuse to operate, even if their prospective patients are willing and able to pay for the operation themselves. It seems to me to be barbaric, irrational and counter-productive to maintain an exclusionary policy that, as a practical matter, is pushing people to make themselves even sicker so that they can have a realistic chance of getting well. For many morbidly obese people, WLS may be the ONLY realistic alternative for achieving a long, healthy life. People genetically or otherwise prone to obesity seem to gain excessive weight easily, while finding it difficult or impossible to lose it. That's why diets almost always fail and why WLS is currently the only viable weight loss option for many morbidly obese people, according to endocrinologist David Cummings of the Veterans Affairs Puget Sound Health Care System. Experience and studies show that most people can lose no more than 5-10% off their "natural" body weight by exercising and eating wisely. Decades of diet studies show that more than 90% of people who lose weight by dieting gain it all back within 5 years. "There are exceptions, but when you are speaking of general rules, the only people who are able to lose more than 10 percent of their body weight and keep it off are people who have had gastric-bypass or other bariatric surgery," Cummings notes. It seems to me to be simple common sense to amend the WLS policies to respect both the patient's dignity and right to choose, and the surgeon's responsibility to evaluate each potential patient on a case by case basis. Guidelines to help doctors make the right decisions would certainly be helpful and valuable. But I believe that the final decisions should be made jointly by patients and doctors assessing each case and situation on its own merits. That's where I stand. Where do you? WLS for Children and Teens: This is another difficult and complicated issue. Many medical and lay people believe strongly that a child or adolescent is not yet capable of fully and rationally evaluating, understanding or making the choice to have WLS. They believe that such a drastic intervention should wait until that youth has had every opportunity to resolve their weight problems by nutritional education, prudent eating plans, exercise, emotional work or therapy, or just time. At first, I tended to agree. Now, however, a new study reviewed in Youth Today by Diana Zuckerman, documents the severe emotional damage that obesity inflicts upon children and teens. These insights, and my own childhood traumas, have changed my opinion. Health-related Quality of Life of Severely Obese Children and Adolescents (by Jeffrey Schwimmer, M.D., Tasha Burwinkle, M.A., and James Varni, Ph.D., in the Journal of the American Medical Association, Vol. 289, April 9, 2003, pgs. 1813-1819) makes an extraordinarily powerful case for letting youths and doctors jointly make their decisions about WLS on a collaborative, individualized, case by case basis. This study shows that the emotional harm caused by severe obesity in young people may be every bit as awful as the physical harm they suffer. According to the children and parents participating in this study, the quality of life of obese children is comparable to that of children who are undergoing chemotherapy for cancer! In the criteria used in the study, children's health-related quality of life was assessed by their ability to move around and participate in sports, their levels of fear and sadness, the quality of their peer relationships, and how much they pay attention in school and do their school work. The study's authors found that obese children were more than five times as likely to have a significantly lower quality of life than the average for "normal" children of their age. The quality of life for 40 – 60% of obese children was impaired by health-related factors, and they suffered severely in terms of their physical, emotional, social and school functioning.
However, having spent my professional life advocating for the best interests of children and teens, I want them to be able to be considered for WLS if they so choose, and if their doctor believes it is justified, and if they commit, and follow through, with a mandatory therapeutic process before their surgery is undertaken. Who knows better than we do the terrible emotional and social pain, humiliation, limitations, discomfort, self-hate, exclusion and discrimination that obese children and youths experience? If we don't responsibly advocate and speak for them, who will? For that matter, if we don't ask the tough questions, and fearlessly share our experience and perspectives, who else will speak effectively for us, and for the countless numbers of others like us out there who are still suffering the ravages of obesity? Our job now is to figure out how we can best discuss, seek consensus, and then express our beliefs, convictions and recommendations to the surgeons and the insurance companies who are presently the only empowered parties at the decision-making table. Whether it's each of us thinking these matters through and speaking out individually, or joining in concert with our email and support groups, or prodding organizations like obesityhelp.com to lead the fight, I respectfully submit that it's time for us to think these weighty matters through, take a stand, and fight for our Brothers and Sisters of the Scale. What do you think? Where do you stand? And what will you do about it? GlennClick here to read another newsletter.
Click here if you have a “fruit and vegetable problem” to see if my solution (see Through Thick and Thin #19) will work for you. |
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Copyright, © 2003, Glenn Goldberg. All rights reserved. |
Through Thick and Thin Newsletters
There are no simple answers to these complex questions. However, the one thing I know for sure is that we, as the community of consumers and survivors of this radical intervention, must begin our own dialogue about these issues so that our voices can be heard and considered as decisions are made that will profoundly affect the lives of hundreds of thousands of our peers. I submit that we have a special responsibility to examine and address these issues, and to provide policy input on behalf of all of those suffering from obesity whose very futures are in stake in this debate.
Now I strongly believe that it's vital for people — all people of all ages — choosing WLS to do their "emotional work" before surgery so that they can discover, and then address, the psychological and emotional reasons for their overeating and obesity. Otherwise, in my experience, they are likely to sabotage their potential for success by letting their "head hunger" drive their continued compulsive overeating through the many tricks and loopholes we all know (and hopefully choose to decline.)
